| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
191 |
$22K |
| D1110 |
Prophylaxis - adult |
526 |
471 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
718 |
646 |
$14K |
| D0274 |
Bitewings - four radiographic images |
441 |
393 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
588 |
522 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
211 |
190 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
362 |
301 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
176 |
$8K |
| D1120 |
Prophylaxis - child |
158 |
139 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
55 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
277 |
227 |
$3K |