| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
61 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
268 |
261 |
$7K |
| D0274 |
Bitewings - four radiographic images |
255 |
248 |
$6K |
| D1206 |
Topical application of fluoride varnish |
313 |
303 |
$4K |
| D1110 |
Prophylaxis - adult |
135 |
134 |
$4K |
| D1120 |
Prophylaxis - child |
162 |
154 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
43 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$665.00 |