| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,563 |
708 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
438 |
436 |
$34K |
| D0330 |
Panoramic radiographic image |
875 |
872 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,258 |
1,252 |
$17K |
| D1110 |
Prophylaxis - adult |
1,303 |
1,291 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
167 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,441 |
1,082 |
$7K |
| D2332 |
|
160 |
90 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
227 |
225 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,338 |
1,330 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,108 |
1,102 |
$3K |
| D1330 |
|
1,493 |
1,485 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,231 |
1,205 |
$645.13 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$132.90 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$74.68 |