| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
67 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,296 |
737 |
$13K |
| D1120 |
Prophylaxis - child |
384 |
369 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
463 |
441 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
783 |
741 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
789 |
749 |
$9K |
| D0274 |
Bitewings - four radiographic images |
226 |
210 |
$6K |
| D1110 |
Prophylaxis - adult |
119 |
113 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
144 |
138 |
$5K |
| D0272 |
Bitewings - two radiographic images |
103 |
100 |
$2K |
| D0603 |
|
955 |
865 |
$0.00 |