| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
943 |
567 |
$93K |
| D1110 |
Prophylaxis - adult |
1,806 |
1,729 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
659 |
393 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,888 |
1,807 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
341 |
238 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,083 |
1,034 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
474 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,216 |
1,157 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
756 |
704 |
$11K |
| D0330 |
Panoramic radiographic image |
189 |
174 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
350 |
327 |
$4K |
| D1120 |
Prophylaxis - child |
135 |
125 |
$3K |
| D2332 |
|
20 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$943.18 |