| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
386 |
213 |
$50K |
| D1120 |
Prophylaxis - child |
964 |
954 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,343 |
1,329 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,415 |
1,400 |
$35K |
| D1110 |
Prophylaxis - adult |
533 |
526 |
$33K |
| D0274 |
Bitewings - four radiographic images |
720 |
712 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
189 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
348 |
344 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
89 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
78 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
13 |
$3K |
| D1330 |
|
352 |
348 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
41 |
$394.00 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$375.00 |