| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
479 |
325 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
835 |
792 |
$15K |
| D1110 |
Prophylaxis - adult |
491 |
475 |
$9K |
| D0274 |
Bitewings - four radiographic images |
637 |
600 |
$5K |
| D1120 |
Prophylaxis - child |
227 |
215 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
651 |
546 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
833 |
779 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
117 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
126 |
113 |
$666.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$130.00 |
| D0270 |
|
42 |
42 |
$126.00 |