| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,370 |
1,257 |
$170K |
| D1110 |
Prophylaxis - adult |
3,500 |
3,423 |
$125K |
| D1120 |
Prophylaxis - child |
1,708 |
1,689 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,279 |
2,239 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,992 |
2,945 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,130 |
1,105 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,964 |
1,859 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
461 |
290 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,495 |
1,483 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,188 |
3,065 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,724 |
1,812 |
$28K |
| D0330 |
Panoramic radiographic image |
432 |
412 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
328 |
198 |
$21K |
| D2394 |
|
37 |
29 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
111 |
$4K |
| D0272 |
Bitewings - two radiographic images |
57 |
56 |
$1K |
| D1320 |
|
345 |
338 |
$1K |
| D0270 |
|
50 |
49 |
$261.24 |
| D1330 |
|
154 |
154 |
$0.00 |