| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
361 |
173 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
802 |
766 |
$13K |
| D0274 |
Bitewings - four radiographic images |
683 |
614 |
$11K |
| D1110 |
Prophylaxis - adult |
357 |
339 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
54 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
338 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
214 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
268 |
249 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
107 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
671 |
592 |
$3K |
| D1120 |
Prophylaxis - child |
154 |
142 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
434 |
140 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
24 |
$509.52 |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$110.00 |