| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
259 |
175 |
$53K |
| D1110 |
Prophylaxis - adult |
541 |
529 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
444 |
429 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
249 |
244 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
386 |
373 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
36 |
$14K |
| D0274 |
Bitewings - four radiographic images |
99 |
97 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
210 |
208 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
103 |
$4K |
| D0602 |
|
81 |
73 |
$0.00 |
| D0601 |
|
158 |
127 |
$0.00 |