| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
772 |
477 |
$56K |
| D1110 |
Prophylaxis - adult |
1,252 |
1,190 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,489 |
1,338 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
576 |
334 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,160 |
1,102 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,556 |
1,498 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
634 |
605 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,488 |
1,395 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,771 |
1,639 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
201 |
142 |
$18K |
| D1120 |
Prophylaxis - child |
275 |
271 |
$12K |
| D2332 |
|
70 |
54 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
313 |
297 |
$7K |
| D2954 |
|
36 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
82 |
81 |
$2K |