| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
608 |
344 |
$48K |
| D0274 |
Bitewings - four radiographic images |
820 |
812 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
682 |
675 |
$23K |
| D1120 |
Prophylaxis - child |
573 |
568 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
946 |
939 |
$17K |
| D1110 |
Prophylaxis - adult |
371 |
370 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,138 |
1,113 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
150 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
951 |
935 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
385 |
382 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
240 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
104 |
$6K |
| D2331 |
|
20 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$1K |