| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
1,348 |
1,150 |
$346K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,782 |
1,470 |
$304K |
| D2335 |
|
657 |
621 |
$175K |
| D2394 |
|
657 |
610 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,217 |
954 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
916 |
707 |
$70K |
| D1110 |
Prophylaxis - adult |
1,617 |
1,612 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,624 |
1,619 |
$35K |
| D0274 |
Bitewings - four radiographic images |
868 |
868 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
889 |
889 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
895 |
895 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
131 |
$6K |