| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
456 |
224 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
700 |
638 |
$23K |
| D1110 |
Prophylaxis - adult |
515 |
471 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
395 |
179 |
$20K |
| D0274 |
Bitewings - four radiographic images |
547 |
501 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
48 |
$5K |
| D2330 |
|
84 |
30 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
364 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
341 |
325 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
96 |
$2K |
| D2332 |
|
22 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
26 |
$949.24 |