| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
509 |
343 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
452 |
272 |
$29K |
| D1110 |
Prophylaxis - adult |
841 |
795 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,458 |
1,356 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,505 |
1,406 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
302 |
207 |
$14K |
| D1120 |
Prophylaxis - child |
549 |
500 |
$12K |
| D0274 |
Bitewings - four radiographic images |
494 |
470 |
$11K |
| D4910 |
|
71 |
68 |
$4K |
| D0272 |
Bitewings - two radiographic images |
127 |
117 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
194 |
185 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$622.58 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$505.65 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$333.46 |