| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
486 |
190 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
609 |
524 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
387 |
305 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
100 |
$17K |
| D1110 |
Prophylaxis - adult |
169 |
156 |
$8K |
| D0274 |
Bitewings - four radiographic images |
110 |
98 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
77 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
311 |
$3K |
| D1120 |
Prophylaxis - child |
60 |
53 |
$2K |
| D0330 |
Panoramic radiographic image |
47 |
39 |
$2K |
| D1206 |
Topical application of fluoride varnish |
75 |
70 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
67 |
60 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
222 |
135 |
$1K |