| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,499 |
2,343 |
$509K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,440 |
1,338 |
$254K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,654 |
1,149 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
5,957 |
5,876 |
$168K |
| D1110 |
Prophylaxis - adult |
3,271 |
3,228 |
$163K |
| D1120 |
Prophylaxis - child |
3,703 |
3,643 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,341 |
5,260 |
$109K |
| D0272 |
Bitewings - two radiographic images |
3,815 |
3,756 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
567 |
557 |
$27K |
| D0330 |
Panoramic radiographic image |
179 |
178 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
734 |
658 |
$9K |
| D2331 |
|
39 |
26 |
$4K |
| D2330 |
|
15 |
12 |
$1K |