| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
709 |
366 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,712 |
1,661 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,162 |
1,127 |
$15K |
| D1110 |
Prophylaxis - adult |
692 |
664 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,015 |
1,926 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
988 |
954 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,619 |
1,520 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
109 |
$7K |
| D1120 |
Prophylaxis - child |
355 |
338 |
$7K |
| D1999 |
|
1,174 |
913 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
79 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
68 |
$1K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$255.06 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$134.62 |