| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,099 |
558 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,084 |
1,040 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
642 |
360 |
$28K |
| D1120 |
Prophylaxis - child |
485 |
479 |
$28K |
| D0330 |
Panoramic radiographic image |
441 |
425 |
$24K |
| D1110 |
Prophylaxis - adult |
440 |
428 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
907 |
886 |
$16K |
| D0274 |
Bitewings - four radiographic images |
445 |
425 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
248 |
248 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
116 |
115 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$401.40 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
24 |
$195.60 |
| D1999 |
|
13 |
12 |
$0.00 |