| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,451 |
1,630 |
$558K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,410 |
1,654 |
$452K |
| D2394 |
|
1,746 |
767 |
$261K |
| D2335 |
|
1,031 |
451 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,560 |
760 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,205 |
3,109 |
$81K |
| D2332 |
|
827 |
458 |
$76K |
| D1110 |
Prophylaxis - adult |
1,949 |
1,885 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,275 |
2,592 |
$61K |
| D0330 |
Panoramic radiographic image |
942 |
893 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,719 |
1,618 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,162 |
1,071 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,131 |
2,915 |
$45K |
| D1120 |
Prophylaxis - child |
1,588 |
1,528 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,525 |
2,455 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
953 |
882 |
$33K |
| D2330 |
|
483 |
255 |
$30K |
| D4355 |
|
361 |
335 |
$22K |
| D0272 |
Bitewings - two radiographic images |
765 |
734 |
$14K |
| D2331 |
|
108 |
67 |
$8K |
| D4341 |
|
59 |
25 |
$5K |