| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,458 |
709 |
$118K |
| D1110 |
Prophylaxis - adult |
1,863 |
1,807 |
$68K |
| D1120 |
Prophylaxis - child |
2,278 |
2,259 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,484 |
3,443 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
3,627 |
3,580 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
773 |
349 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,285 |
2,149 |
$36K |
| D9910 |
|
1,121 |
1,111 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,755 |
2,496 |
$24K |
| D0274 |
Bitewings - four radiographic images |
912 |
881 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
62 |
$14K |
| D0272 |
Bitewings - two radiographic images |
554 |
543 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
373 |
311 |
$8K |
| D0330 |
Panoramic radiographic image |
82 |
79 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
105 |
$2K |
| D9994 |
|
309 |
304 |
$2K |
| D9995 |
|
15 |
15 |
$420.00 |
| D9992 |
|
14 |
14 |
$99.36 |