| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
607 |
387 |
$67K |
| D1120 |
Prophylaxis - child |
1,744 |
1,743 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,162 |
2,161 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,237 |
2,234 |
$50K |
| D1110 |
Prophylaxis - adult |
984 |
982 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
1,394 |
1,380 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
163 |
$20K |
| D0274 |
Bitewings - four radiographic images |
541 |
540 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,524 |
1,142 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
304 |
$13K |
| D0272 |
Bitewings - two radiographic images |
317 |
316 |
$6K |
| D0330 |
Panoramic radiographic image |
85 |
85 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
54 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$2K |
| D9986 |
|
13 |
13 |
$0.00 |