| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,561 |
646 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
789 |
286 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
412 |
226 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,463 |
1,417 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,567 |
1,532 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
561 |
537 |
$28K |
| D1120 |
Prophylaxis - child |
589 |
573 |
$25K |
| D0274 |
Bitewings - four radiographic images |
803 |
780 |
$25K |
| D1110 |
Prophylaxis - adult |
742 |
718 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
368 |
354 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
838 |
445 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
526 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$418.56 |