| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,040 |
1,137 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,026 |
1,906 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
907 |
502 |
$38K |
| D0330 |
Panoramic radiographic image |
977 |
915 |
$35K |
| D1120 |
Prophylaxis - child |
744 |
692 |
$33K |
| D1110 |
Prophylaxis - adult |
846 |
778 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,201 |
1,115 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
444 |
353 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,448 |
1,344 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
320 |
308 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
497 |
461 |
$4K |
| D2394 |
|
14 |
13 |
$991.45 |
| D2331 |
|
18 |
12 |
$822.25 |
| D9110 |
|
15 |
13 |
$268.17 |
| D1999 |
|
74 |
60 |
$0.00 |