| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,177 |
809 |
$119K |
| D1110 |
Prophylaxis - adult |
2,209 |
2,113 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
466 |
367 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,359 |
2,325 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,834 |
1,736 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,507 |
2,340 |
$55K |
| D0330 |
Panoramic radiographic image |
1,078 |
1,020 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,967 |
2,762 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,043 |
960 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
477 |
346 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
383 |
354 |
$12K |
| D2331 |
|
152 |
102 |
$12K |
| D1206 |
Topical application of fluoride varnish |
657 |
612 |
$10K |
| D2330 |
|
128 |
84 |
$8K |
| D2332 |
|
56 |
43 |
$5K |
| D2335 |
|
34 |
28 |
$4K |
| D4341 |
|
28 |
13 |
$3K |
| D4346 |
|
61 |
57 |
$2K |
| D1120 |
Prophylaxis - child |
30 |
30 |
$825.34 |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$696.60 |