| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
477 |
195 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
190 |
101 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
442 |
$11K |
| D0330 |
Panoramic radiographic image |
214 |
209 |
$8K |
| D1120 |
Prophylaxis - child |
166 |
160 |
$7K |
| D0274 |
Bitewings - four radiographic images |
244 |
238 |
$5K |
| D1110 |
Prophylaxis - adult |
112 |
109 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
51 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
203 |
199 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
168 |
$1K |
| D2331 |
|
15 |
12 |
$851.40 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$615.45 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$214.76 |
| D9986 |
|
102 |
90 |
$0.00 |