| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,809 |
1,622 |
$376K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,537 |
1,636 |
$223K |
| D2330 |
|
1,978 |
882 |
$96K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
893 |
502 |
$74K |
| D1110 |
Prophylaxis - adult |
1,965 |
1,957 |
$69K |
| D2335 |
|
477 |
255 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,276 |
2,268 |
$44K |
| D0330 |
Panoramic radiographic image |
893 |
890 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
987 |
936 |
$17K |
| D0274 |
Bitewings - four radiographic images |
798 |
793 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
1,193 |
1,186 |
$8K |
| D2394 |
|
29 |
25 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
185 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$266.80 |