| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,385 |
2,259 |
$450K |
| D2332 |
|
1,321 |
932 |
$124K |
| D1110 |
Prophylaxis - adult |
2,655 |
2,549 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
2,997 |
2,892 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,761 |
1,640 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
377 |
300 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,351 |
2,269 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,038 |
982 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
239 |
179 |
$18K |
| D1120 |
Prophylaxis - child |
609 |
594 |
$16K |
| D0330 |
Panoramic radiographic image |
150 |
132 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
151 |
$7K |
| D0272 |
Bitewings - two radiographic images |
319 |
313 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
78 |
$1K |
| D1999 |
|
24 |
24 |
$0.00 |