| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
89 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
485 |
447 |
$21K |
| D1206 |
Topical application of fluoride varnish |
698 |
662 |
$18K |
| D1110 |
Prophylaxis - adult |
132 |
123 |
$10K |
| D0274 |
Bitewings - four radiographic images |
96 |
92 |
$5K |
| D1120 |
Prophylaxis - child |
86 |
83 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$4K |
| D0272 |
Bitewings - two radiographic images |
44 |
42 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$1K |