| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,445 |
634 |
$97K |
| D1110 |
Prophylaxis - adult |
1,095 |
1,077 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,781 |
1,757 |
$28K |
| D1120 |
Prophylaxis - child |
959 |
947 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,288 |
1,278 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
607 |
580 |
$15K |
| D0274 |
Bitewings - four radiographic images |
777 |
759 |
$15K |
| D0330 |
Panoramic radiographic image |
257 |
235 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
73 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
40 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
309 |
293 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
96 |
94 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
40 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$818.15 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
27 |
$316.35 |
| D4910 |
|
26 |
26 |
$0.00 |