| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,329 |
596 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
585 |
374 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,149 |
1,005 |
$23K |
| D1120 |
Prophylaxis - child |
577 |
575 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
486 |
$17K |
| D1110 |
Prophylaxis - adult |
280 |
279 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
992 |
990 |
$14K |
| D0274 |
Bitewings - four radiographic images |
518 |
518 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
429 |
428 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,014 |
1,009 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
86 |
$6K |
| D0272 |
Bitewings - two radiographic images |
171 |
171 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
28 |
$544.62 |
| D0603 |
|
1,129 |
1,126 |
$0.00 |
| D0330 |
Panoramic radiographic image |
84 |
84 |
$0.00 |