| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
659 |
312 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,399 |
1,385 |
$39K |
| D1110 |
Prophylaxis - adult |
960 |
951 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
978 |
966 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
239 |
132 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,735 |
1,694 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,622 |
1,593 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
142 |
$11K |
| D9110 |
|
354 |
344 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
478 |
$10K |
| D0330 |
Panoramic radiographic image |
185 |
183 |
$7K |
| D1206 |
Topical application of fluoride varnish |
352 |
351 |
$7K |
| D1330 |
|
936 |
928 |
$5K |
| D1310 |
|
911 |
903 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
216 |
211 |
$4K |
| D2332 |
|
42 |
28 |
$4K |
| D1320 |
|
198 |
196 |
$3K |
| D0602 |
|
137 |
134 |
$1K |
| D0603 |
|
89 |
88 |
$830.00 |
| D1120 |
Prophylaxis - child |
29 |
29 |
$823.73 |