| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
208 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
720 |
$22K |
| D1110 |
Prophylaxis - adult |
459 |
455 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
284 |
$17K |
| D1206 |
Topical application of fluoride varnish |
559 |
555 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
96 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
759 |
742 |
$9K |
| D0274 |
Bitewings - four radiographic images |
284 |
280 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
323 |
318 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
799 |
437 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
140 |
139 |
$3K |
| D1120 |
Prophylaxis - child |
73 |
73 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$248.05 |