| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,441 |
587 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
2,143 |
2,138 |
$62K |
| D1110 |
Prophylaxis - adult |
971 |
970 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,594 |
2,302 |
$53K |
| D1120 |
Prophylaxis - child |
1,256 |
1,253 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,362 |
2,358 |
$35K |
| D0274 |
Bitewings - four radiographic images |
940 |
938 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,359 |
2,346 |
$29K |
| D0272 |
Bitewings - two radiographic images |
807 |
804 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
104 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
56 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
49 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$459.16 |
| D0603 |
|
2,463 |
2,454 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |