| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,042 |
511 |
$71K |
| D1110 |
Prophylaxis - adult |
1,381 |
1,357 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,612 |
1,596 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,109 |
1,103 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,159 |
1,847 |
$18K |
| D0274 |
Bitewings - four radiographic images |
845 |
827 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,078 |
1,218 |
$17K |
| D9630 |
|
936 |
931 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
90 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
265 |
258 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
39 |
$5K |
| D9310 |
|
92 |
64 |
$5K |
| D1120 |
Prophylaxis - child |
112 |
112 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
83 |
$1K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$282.10 |
| D4910 |
|
40 |
40 |
$0.00 |