| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
298 |
165 |
$22K |
| D1110 |
Prophylaxis - adult |
279 |
268 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
278 |
275 |
$8K |
| D0330 |
Panoramic radiographic image |
199 |
195 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
232 |
$5K |
| D1206 |
Topical application of fluoride varnish |
206 |
200 |
$4K |
| D0274 |
Bitewings - four radiographic images |
153 |
150 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
39 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
235 |
220 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
65 |
58 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |