| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,176 |
1,141 |
$209K |
| D1110 |
Prophylaxis - adult |
3,507 |
3,216 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,357 |
588 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,358 |
3,173 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,263 |
1,144 |
$58K |
| D1120 |
Prophylaxis - child |
1,349 |
1,343 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
402 |
268 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
980 |
884 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,738 |
1,719 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,036 |
1,031 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,222 |
1,101 |
$14K |
| D0274 |
Bitewings - four radiographic images |
588 |
474 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
824 |
720 |
$8K |
| D1206 |
Topical application of fluoride varnish |
159 |
159 |
$5K |
| D2394 |
|
38 |
25 |
$5K |
| D1999 |
|
19 |
16 |
$0.00 |