| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
519 |
495 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
604 |
572 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
121 |
103 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
102 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
282 |
244 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
172 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
169 |
137 |
$2K |
| D2140 |
|
45 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$415.56 |