| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
121 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
225 |
$10K |
| D1110 |
Prophylaxis - adult |
231 |
219 |
$8K |
| D0330 |
Panoramic radiographic image |
144 |
134 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
415 |
365 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
545 |
229 |
$6K |
| D0274 |
Bitewings - four radiographic images |
148 |
141 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
98 |
96 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
195 |
181 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |