| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,189 |
589 |
$251K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,555 |
518 |
$143K |
| D2394 |
|
901 |
336 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
947 |
794 |
$36K |
| D0330 |
Panoramic radiographic image |
834 |
718 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,207 |
834 |
$20K |
| D1110 |
Prophylaxis - adult |
534 |
458 |
$17K |
| D0274 |
Bitewings - four radiographic images |
669 |
586 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
123 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,031 |
877 |
$13K |
| D2332 |
|
120 |
63 |
$11K |
| D2335 |
|
59 |
24 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
269 |
248 |
$6K |
| D1120 |
Prophylaxis - child |
197 |
179 |
$5K |
| D4341 |
|
52 |
14 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
215 |
189 |
$3K |
| D4355 |
|
33 |
28 |
$2K |
| D2330 |
|
16 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
28 |
$1K |
| D0272 |
Bitewings - two radiographic images |
61 |
58 |
$967.50 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$402.72 |