| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
579 |
283 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
774 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
470 |
446 |
$25K |
| D1110 |
Prophylaxis - adult |
524 |
494 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
111 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
322 |
294 |
$7K |
| D1120 |
Prophylaxis - child |
334 |
298 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
280 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
258 |
236 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
348 |
170 |
$3K |
| D0330 |
Panoramic radiographic image |
85 |
83 |
$3K |
| D0274 |
Bitewings - four radiographic images |
119 |
111 |
$2K |
| D1351 |
Sealant - per tooth |
95 |
26 |
$2K |
| D1206 |
Topical application of fluoride varnish |
94 |
83 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
40 |
$527.71 |
| D1330 |
|
16 |
15 |
$0.00 |
| D1310 |
|
16 |
15 |
$0.00 |