| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
373 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
584 |
286 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
831 |
$19K |
| D0330 |
Panoramic radiographic image |
381 |
346 |
$12K |
| D1120 |
Prophylaxis - child |
275 |
266 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
648 |
610 |
$9K |
| D0274 |
Bitewings - four radiographic images |
292 |
261 |
$6K |
| D1110 |
Prophylaxis - adult |
144 |
133 |
$5K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
55 |
$413.39 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$340.50 |