| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
792 |
498 |
$91K |
| D1110 |
Prophylaxis - adult |
1,481 |
1,381 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
583 |
401 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,656 |
1,567 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,473 |
1,410 |
$25K |
| D0274 |
Bitewings - four radiographic images |
921 |
864 |
$24K |
| D1120 |
Prophylaxis - child |
663 |
641 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
367 |
335 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
27 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
271 |
242 |
$4K |
| D0330 |
Panoramic radiographic image |
64 |
61 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
70 |
$3K |
| D0270 |
|
25 |
25 |
$253.00 |