| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,021 |
570 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
585 |
371 |
$61K |
| D1110 |
Prophylaxis - adult |
945 |
936 |
$34K |
| D0274 |
Bitewings - four radiographic images |
757 |
748 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,027 |
1,015 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
531 |
515 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
775 |
766 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
113 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
178 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
526 |
511 |
$4K |
| D1120 |
Prophylaxis - child |
154 |
153 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
322 |
294 |
$2K |
| D2394 |
|
16 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |