| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
827 |
552 |
$53K |
| D1110 |
Prophylaxis - adult |
863 |
856 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
416 |
305 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
860 |
850 |
$27K |
| D0274 |
Bitewings - four radiographic images |
605 |
598 |
$19K |
| D0330 |
Panoramic radiographic image |
306 |
303 |
$19K |
| D2394 |
|
231 |
179 |
$18K |
| D9110 |
|
290 |
281 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
528 |
521 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
294 |
292 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
768 |
742 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
93 |
$6K |
| D1120 |
Prophylaxis - child |
77 |
73 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
406 |
226 |
$3K |