| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
465 |
214 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
251 |
134 |
$23K |
| D1110 |
Prophylaxis - adult |
502 |
477 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
235 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
321 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
139 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
26 |
$2K |
| D2394 |
|
17 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
128 |
$2K |
| D2332 |
|
16 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
48 |
46 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
45 |
44 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
14 |
$298.35 |