| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
597 |
367 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,428 |
1,372 |
$43K |
| D1120 |
Prophylaxis - child |
917 |
895 |
$39K |
| D1110 |
Prophylaxis - adult |
629 |
605 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,080 |
1,053 |
$27K |
| D0272 |
Bitewings - two radiographic images |
657 |
638 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
137 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
72 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
51 |
45 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$650.40 |