| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,259 |
1,497 |
$317K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,574 |
856 |
$159K |
| D1110 |
Prophylaxis - adult |
2,270 |
2,227 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
2,592 |
2,541 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
955 |
532 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,352 |
2,298 |
$58K |
| D1120 |
Prophylaxis - child |
1,211 |
1,199 |
$42K |
| D0330 |
Panoramic radiographic image |
1,178 |
1,155 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,292 |
2,255 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
656 |
640 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
236 |
236 |
$16K |
| D0272 |
Bitewings - two radiographic images |
816 |
810 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
94 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
666 |
662 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
869 |
811 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
350 |
346 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
24 |
$149.63 |
| D0603 |
|
3,754 |
3,707 |
$0.00 |