| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,238 |
719 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,370 |
1,217 |
$54K |
| D1110 |
Prophylaxis - adult |
939 |
927 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,323 |
1,299 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
881 |
873 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,253 |
1,124 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,413 |
1,380 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
598 |
585 |
$20K |
| D0330 |
Panoramic radiographic image |
484 |
477 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
186 |
130 |
$15K |
| D4910 |
|
236 |
223 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
484 |
468 |
$12K |
| D0603 |
|
309 |
301 |
$3K |
| D4341 |
|
21 |
12 |
$2K |
| D4355 |
|
29 |
29 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
24 |
$2K |
| D9630 |
|
18 |
13 |
$247.00 |
| D1330 |
|
25 |
25 |
$170.00 |