| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,920 |
1,148 |
$133K |
| D1110 |
Prophylaxis - adult |
2,581 |
2,579 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,769 |
3,765 |
$82K |
| D2332 |
|
818 |
525 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,036 |
1,033 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,854 |
1,854 |
$40K |
| D7510 |
|
786 |
774 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
668 |
520 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,013 |
1,968 |
$25K |
| D0330 |
Panoramic radiographic image |
695 |
695 |
$20K |
| D2335 |
|
46 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
466 |
466 |
$4K |
| D9110 |
|
119 |
114 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$830.74 |