| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,188 |
2,087 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,759 |
1,236 |
$102K |
| D1110 |
Prophylaxis - adult |
2,200 |
2,142 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,371 |
3,253 |
$87K |
| D0330 |
Panoramic radiographic image |
2,035 |
1,961 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,663 |
2,581 |
$63K |
| D1120 |
Prophylaxis - child |
997 |
944 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
981 |
762 |
$40K |
| D2335 |
|
425 |
229 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
634 |
611 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,612 |
1,260 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,257 |
2,171 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
841 |
793 |
$12K |
| D2332 |
|
173 |
122 |
$11K |
| D1206 |
Topical application of fluoride varnish |
760 |
735 |
$10K |
| D0272 |
Bitewings - two radiographic images |
277 |
259 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
112 |
$4K |
| D2394 |
|
50 |
40 |
$3K |