| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
654 |
282 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
336 |
191 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
424 |
343 |
$19K |
| D1110 |
Prophylaxis - adult |
367 |
367 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
553 |
553 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
224 |
224 |
$6K |
| D9110 |
|
146 |
113 |
$4K |
| D2332 |
|
38 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
480 |
475 |
$2K |
| D1120 |
Prophylaxis - child |
53 |
53 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
26 |
$2K |
| D2330 |
|
40 |
27 |
$2K |
| D0274 |
Bitewings - four radiographic images |
145 |
145 |
$2K |
| D2335 |
|
17 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
335 |
335 |
$1K |
| D2331 |
|
16 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$585.00 |