| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
127 |
$13K |
| D9630 |
|
614 |
594 |
$9K |
| D9920 |
|
123 |
107 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
576 |
559 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
954 |
848 |
$8K |
| D1110 |
Prophylaxis - adult |
286 |
281 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
76 |
$5K |
| D1206 |
Topical application of fluoride varnish |
243 |
225 |
$5K |
| D0274 |
Bitewings - four radiographic images |
221 |
211 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
82 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
307 |
203 |
$2K |
| D1120 |
Prophylaxis - child |
60 |
53 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
57 |
$2K |