| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
40 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
328 |
310 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
69 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
112 |
$5K |
| D0274 |
Bitewings - four radiographic images |
135 |
131 |
$4K |
| D1110 |
Prophylaxis - adult |
76 |
74 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
212 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$440.30 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$373.64 |