| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,601 |
2,098 |
$205K |
| D1110 |
Prophylaxis - adult |
4,653 |
4,263 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,752 |
1,522 |
$128K |
| D0274 |
Bitewings - four radiographic images |
3,713 |
3,402 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,825 |
3,593 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,443 |
2,206 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
682 |
483 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,737 |
1,528 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,083 |
994 |
$44K |
| D1120 |
Prophylaxis - child |
718 |
666 |
$28K |
| D2331 |
|
391 |
227 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
697 |
627 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,522 |
1,381 |
$15K |
| D2330 |
|
151 |
82 |
$7K |
| D2332 |
|
75 |
51 |
$7K |
| D2791 |
|
15 |
12 |
$6K |
| D2940 |
|
30 |
25 |
$803.00 |
| D0330 |
Panoramic radiographic image |
16 |
13 |
$396.72 |