| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
305 |
129 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,022 |
1,017 |
$29K |
| D1120 |
Prophylaxis - child |
589 |
586 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,220 |
1,216 |
$17K |
| D0272 |
Bitewings - two radiographic images |
734 |
731 |
$17K |
| D1110 |
Prophylaxis - adult |
298 |
296 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,145 |
1,139 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,126 |
1,122 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
16 |
$2K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
33 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$766.40 |
| D0601 |
|
585 |
581 |
$0.00 |
| D0603 |
|
268 |
268 |
$0.00 |
| D0602 |
|
191 |
190 |
$0.00 |