| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
491 |
$66K |
| D1120 |
Prophylaxis - child |
1,886 |
1,870 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,946 |
2,914 |
$58K |
| D1110 |
Prophylaxis - adult |
1,443 |
1,417 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,437 |
2,408 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
98 |
$11K |
| D0272 |
Bitewings - two radiographic images |
530 |
526 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
286 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
51 |
$7K |
| D0274 |
Bitewings - four radiographic images |
307 |
299 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
488 |
463 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
102 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
412 |
259 |
$4K |
| D0330 |
Panoramic radiographic image |
63 |
63 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$266.50 |
| D1999 |
|
62 |
59 |
$0.00 |