| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
973 |
436 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
783 |
398 |
$50K |
| D1110 |
Prophylaxis - adult |
1,714 |
1,548 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,737 |
1,536 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,034 |
950 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,421 |
1,264 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
483 |
458 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,555 |
1,271 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,719 |
1,552 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
679 |
606 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
422 |
397 |
$13K |
| D1120 |
Prophylaxis - child |
209 |
197 |
$8K |
| D1206 |
Topical application of fluoride varnish |
476 |
431 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
45 |
$4K |
| D2332 |
|
28 |
14 |
$2K |
| D2394 |
|
14 |
12 |
$1K |
| D0350 |
|
150 |
138 |
$0.00 |
| D9986 |
|
195 |
188 |
$0.00 |
| D0707 |
|
29 |
27 |
$0.00 |
| D1330 |
|
848 |
748 |
$0.00 |