| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
602 |
397 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
705 |
443 |
$60K |
| D1110 |
Prophylaxis - adult |
440 |
434 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
673 |
659 |
$25K |
| D0274 |
Bitewings - four radiographic images |
493 |
481 |
$23K |
| D1206 |
Topical application of fluoride varnish |
761 |
748 |
$21K |
| D0330 |
Panoramic radiographic image |
218 |
215 |
$18K |
| D1120 |
Prophylaxis - child |
406 |
397 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
37 |
$7K |
| D0272 |
Bitewings - two radiographic images |
212 |
210 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
104 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
64 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
172 |
$4K |