| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
96 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
157 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
68 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
28 |
$4K |
| D4341 |
|
44 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
151 |
145 |
$3K |
| D1120 |
Prophylaxis - child |
45 |
45 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
150 |
149 |
$2K |
| D0274 |
Bitewings - four radiographic images |
78 |
75 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |
| D4910 |
|
13 |
13 |
$1K |