| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
362 |
204 |
$41K |
| D1120 |
Prophylaxis - child |
973 |
968 |
$36K |
| D1110 |
Prophylaxis - adult |
792 |
771 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,317 |
1,304 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
194 |
109 |
$18K |
| D1206 |
Topical application of fluoride varnish |
756 |
752 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
373 |
365 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
197 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
704 |
684 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
137 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
463 |
441 |
$4K |
| D0274 |
Bitewings - four radiographic images |
80 |
76 |
$2K |