| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,277 |
272 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,200 |
362 |
$88K |
| D1110 |
Prophylaxis - adult |
1,650 |
1,646 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,150 |
349 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
2,098 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
677 |
287 |
$38K |
| D0330 |
Panoramic radiographic image |
1,214 |
1,207 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,295 |
1,289 |
$24K |
| D1120 |
Prophylaxis - child |
321 |
320 |
$9K |
| D2394 |
|
74 |
39 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
482 |
480 |
$5K |
| D2332 |
|
49 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
67 |
$429.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
39 |
$422.10 |