| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,345 |
785 |
$104K |
| D1120 |
Prophylaxis - child |
2,629 |
2,587 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,433 |
3,387 |
$77K |
| D1110 |
Prophylaxis - adult |
1,595 |
1,575 |
$71K |
| D1206 |
Topical application of fluoride varnish |
3,839 |
3,782 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
625 |
396 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,964 |
1,933 |
$42K |
| D0274 |
Bitewings - four radiographic images |
773 |
761 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
535 |
523 |
$17K |
| D0330 |
Panoramic radiographic image |
221 |
215 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
66 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
187 |
185 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$172.07 |