| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
794 |
491 |
$79K |
| D4355 |
|
637 |
609 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,384 |
1,343 |
$34K |
| D0240 |
|
2,189 |
1,043 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
418 |
224 |
$32K |
| D0274 |
Bitewings - four radiographic images |
932 |
880 |
$28K |
| D0330 |
Panoramic radiographic image |
409 |
387 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
461 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,064 |
1,028 |
$17K |
| D1110 |
Prophylaxis - adult |
440 |
426 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
86 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
951 |
884 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
331 |
304 |
$11K |
| D1120 |
Prophylaxis - child |
365 |
353 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
751 |
376 |
$9K |
| D2332 |
|
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
86 |
81 |
$1K |