| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
646 |
366 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
367 |
367 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
502 |
502 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
294 |
185 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
320 |
$21K |
| D1120 |
Prophylaxis - child |
316 |
316 |
$16K |
| D0350 |
|
1,263 |
514 |
$12K |
| D4341 |
|
158 |
61 |
$11K |
| D1110 |
Prophylaxis - adult |
78 |
78 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
54 |
$4K |
| D0274 |
Bitewings - four radiographic images |
196 |
196 |
$4K |
| D1206 |
Topical application of fluoride varnish |
266 |
266 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
200 |
200 |
$3K |
| D1320 |
|
166 |
166 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
518 |
269 |
$2K |
| D9430 |
|
59 |
54 |
$2K |
| D4910 |
|
13 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
57 |
$720.00 |