| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
343 |
158 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,691 |
1,559 |
$25K |
| D1120 |
Prophylaxis - child |
578 |
564 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
807 |
762 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
789 |
748 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,779 |
1,309 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
433 |
$17K |
| D0274 |
Bitewings - four radiographic images |
765 |
708 |
$14K |
| D1110 |
Prophylaxis - adult |
384 |
362 |
$14K |
| D0272 |
Bitewings - two radiographic images |
395 |
380 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
220 |
200 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
24 |
$5K |
| D1206 |
Topical application of fluoride varnish |
128 |
121 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
52 |
$1K |
| D1999 |
|
449 |
371 |
$0.00 |