| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
69 |
$22K |
| D0330 |
Panoramic radiographic image |
110 |
108 |
$6K |
| D1206 |
Topical application of fluoride varnish |
213 |
209 |
$5K |
| D1110 |
Prophylaxis - adult |
83 |
80 |
$4K |
| D0274 |
Bitewings - four radiographic images |
115 |
111 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
93 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$4K |
| D1120 |
Prophylaxis - child |
99 |
98 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
95 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
112 |
109 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
108 |
$2K |
| D0272 |
Bitewings - two radiographic images |
91 |
90 |
$2K |