| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
997 |
593 |
$87K |
| D1110 |
Prophylaxis - adult |
1,487 |
1,449 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,125 |
1,092 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,502 |
1,461 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,660 |
1,621 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
90 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
382 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
290 |
282 |
$10K |
| D1120 |
Prophylaxis - child |
218 |
215 |
$7K |
| D1206 |
Topical application of fluoride varnish |
264 |
258 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
116 |
$723.77 |
| D0140 |
Limited oral evaluation - problem focused |
40 |
38 |
$411.48 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |