| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
925 |
516 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,495 |
3,211 |
$84K |
| D1110 |
Prophylaxis - adult |
2,193 |
2,000 |
$77K |
| D1206 |
Topical application of fluoride varnish |
3,438 |
3,172 |
$52K |
| D1120 |
Prophylaxis - child |
1,902 |
1,759 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,293 |
1,688 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,213 |
2,011 |
$31K |
| D0274 |
Bitewings - four radiographic images |
831 |
740 |
$22K |
| D0272 |
Bitewings - two radiographic images |
817 |
746 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
54 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
236 |
$10K |
| D0330 |
Panoramic radiographic image |
116 |
114 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
55 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$224.77 |