| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
237 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
336 |
330 |
$9K |
| D1120 |
Prophylaxis - child |
262 |
253 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
413 |
403 |
$6K |
| D0272 |
Bitewings - two radiographic images |
233 |
225 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
383 |
371 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
37 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
356 |
348 |
$4K |
| D2940 |
|
72 |
43 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$2K |
| D3120 |
|
70 |
42 |
$2K |
| D1330 |
|
366 |
320 |
$2K |
| D1110 |
Prophylaxis - adult |
19 |
19 |
$987.84 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$622.98 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
14 |
$494.48 |
| D0602 |
|
560 |
544 |
$0.00 |