| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
663 |
389 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,699 |
2,601 |
$68K |
| D1110 |
Prophylaxis - adult |
1,711 |
1,625 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
1,913 |
1,769 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,521 |
1,458 |
$24K |
| D0274 |
Bitewings - four radiographic images |
723 |
686 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,657 |
1,199 |
$18K |
| D1120 |
Prophylaxis - child |
678 |
663 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
56 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
172 |
$6K |
| D0330 |
Panoramic radiographic image |
79 |
78 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
64 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$1K |
| D1999 |
|
763 |
719 |
$0.00 |