| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
491 |
356 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
802 |
763 |
$21K |
| D1110 |
Prophylaxis - adult |
417 |
405 |
$18K |
| D1120 |
Prophylaxis - child |
334 |
311 |
$13K |
| D9110 |
|
239 |
237 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
643 |
631 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,560 |
1,487 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
382 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
54 |
$5K |
| D2332 |
|
38 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
66 |
$2K |
| D0274 |
Bitewings - four radiographic images |
110 |
101 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
157 |
$1K |