| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,849 |
1,683 |
$240K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,451 |
1,031 |
$106K |
| D1110 |
Prophylaxis - adult |
2,700 |
2,504 |
$90K |
| D1120 |
Prophylaxis - child |
2,953 |
2,745 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
3,129 |
2,790 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,227 |
3,917 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,235 |
4,864 |
$69K |
| D0330 |
Panoramic radiographic image |
1,429 |
1,320 |
$58K |
| D1999 |
|
2,898 |
2,495 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,626 |
1,517 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,328 |
1,215 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,538 |
1,408 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
51 |
$470.05 |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$461.10 |