| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,981 |
1,150 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,825 |
1,007 |
$171K |
| D1110 |
Prophylaxis - adult |
1,957 |
1,957 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,384 |
3,380 |
$91K |
| D1120 |
Prophylaxis - child |
1,843 |
1,843 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,929 |
1,929 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,448 |
2,448 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,011 |
990 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,159 |
2,113 |
$34K |
| D4346 |
|
436 |
436 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
373 |
373 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,636 |
1,427 |
$15K |
| D0240 |
|
454 |
228 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
41 |
$7K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$1K |