| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
907 |
549 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
606 |
422 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
3,070 |
3,054 |
$24K |
| D1110 |
Prophylaxis - adult |
2,015 |
2,006 |
$23K |
| D2335 |
|
230 |
152 |
$13K |
| D1120 |
Prophylaxis - child |
1,036 |
1,032 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
680 |
578 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,295 |
1,291 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,549 |
1,543 |
$8K |
| D2332 |
|
163 |
117 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
910 |
904 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
128 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,174 |
2,133 |
$4K |
| D9110 |
|
520 |
431 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,855 |
1,788 |
$3K |
| D2330 |
|
65 |
44 |
$2K |
| D2331 |
|
30 |
26 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
164 |
$1K |
| D1351 |
Sealant - per tooth |
110 |
13 |
$891.00 |