| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
56 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
311 |
304 |
$6K |
| D1110 |
Prophylaxis - adult |
107 |
104 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
198 |
193 |
$5K |
| D1120 |
Prophylaxis - child |
132 |
129 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
92 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
301 |
298 |
$4K |
| D0274 |
Bitewings - four radiographic images |
127 |
125 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
269 |
207 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
49 |
$2K |