| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
520 |
262 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
712 |
655 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
951 |
873 |
$44K |
| D1110 |
Prophylaxis - adult |
568 |
538 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
154 |
77 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
501 |
483 |
$16K |
| D0274 |
Bitewings - four radiographic images |
291 |
283 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
476 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
593 |
393 |
$8K |
| D1206 |
Topical application of fluoride varnish |
261 |
238 |
$7K |
| D4341 |
|
38 |
16 |
$4K |
| D1120 |
Prophylaxis - child |
45 |
41 |
$2K |
| D4355 |
|
12 |
12 |
$2K |
| D4910 |
|
29 |
27 |
$525.64 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$396.35 |
| D0602 |
|
14 |
13 |
$0.00 |