| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,437 |
891 |
$281K |
| D1110 |
Prophylaxis - adult |
2,154 |
2,052 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,349 |
632 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,117 |
2,001 |
$88K |
| D0330 |
Panoramic radiographic image |
1,880 |
1,769 |
$77K |
| D1206 |
Topical application of fluoride varnish |
2,466 |
2,358 |
$54K |
| D2394 |
|
448 |
260 |
$51K |
| D2332 |
|
318 |
132 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
654 |
640 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
205 |
95 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
362 |
337 |
$12K |
| D0274 |
Bitewings - four radiographic images |
668 |
650 |
$10K |
| D4341 |
|
177 |
53 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
489 |
429 |
$6K |
| D1999 |
|
251 |
172 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
150 |
76 |
$395.67 |