| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,231 |
557 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,071 |
466 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,948 |
1,921 |
$39K |
| D1110 |
Prophylaxis - adult |
1,428 |
1,417 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,549 |
1,534 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,061 |
2,029 |
$20K |
| D1120 |
Prophylaxis - child |
1,008 |
987 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
283 |
273 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
253 |
250 |
$9K |
| D0330 |
Panoramic radiographic image |
383 |
383 |
$9K |
| D0272 |
Bitewings - two radiographic images |
601 |
593 |
$7K |
| D1206 |
Topical application of fluoride varnish |
209 |
209 |
$3K |