| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,011 |
994 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,140 |
1,966 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
804 |
498 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,408 |
1,300 |
$45K |
| D1110 |
Prophylaxis - adult |
1,185 |
1,111 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,078 |
1,010 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,523 |
1,429 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
273 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,550 |
2,378 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
593 |
571 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,102 |
1,050 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,751 |
1,397 |
$5K |
| D1120 |
Prophylaxis - child |
122 |
110 |
$2K |
| D2332 |
|
38 |
28 |
$2K |
| D2394 |
|
21 |
12 |
$988.24 |
| D1206 |
Topical application of fluoride varnish |
13 |
12 |
$299.01 |