| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
985 |
546 |
$65K |
| D1110 |
Prophylaxis - adult |
1,446 |
1,427 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,209 |
1,193 |
$29K |
| D1206 |
Topical application of fluoride varnish |
973 |
952 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
458 |
287 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
615 |
607 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
301 |
299 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
116 |
$12K |
| D0274 |
Bitewings - four radiographic images |
999 |
983 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
363 |
357 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,313 |
1,226 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,347 |
1,324 |
$6K |
| D1120 |
Prophylaxis - child |
87 |
86 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
66 |
$3K |
| D0603 |
|
241 |
239 |
$1K |