| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
382 |
137 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
717 |
553 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
611 |
421 |
$16K |
| D1120 |
Prophylaxis - child |
760 |
535 |
$15K |
| D1206 |
Topical application of fluoride varnish |
536 |
426 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
163 |
93 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$478.50 |