| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,989 |
1,580 |
$375K |
| D2394 |
|
1,530 |
948 |
$235K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,267 |
1,226 |
$226K |
| D2335 |
|
1,015 |
522 |
$127K |
| D0330 |
Panoramic radiographic image |
2,165 |
2,067 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,005 |
2,842 |
$121K |
| D0274 |
Bitewings - four radiographic images |
2,844 |
2,720 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
5,537 |
5,047 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,189 |
4,153 |
$71K |
| D1110 |
Prophylaxis - adult |
1,879 |
1,755 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
842 |
534 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,314 |
2,181 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
968 |
916 |
$33K |
| D2330 |
|
318 |
208 |
$21K |
| D2332 |
|
223 |
136 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,032 |
966 |
$16K |
| D4355 |
|
158 |
138 |
$9K |
| D1120 |
Prophylaxis - child |
270 |
262 |
$7K |
| D0272 |
Bitewings - two radiographic images |
122 |
117 |
$2K |
| D1351 |
Sealant - per tooth |
46 |
13 |
$1K |