| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,597 |
1,185 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,180 |
1,039 |
$206K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,686 |
698 |
$164K |
| D2335 |
|
1,045 |
319 |
$113K |
| D1110 |
Prophylaxis - adult |
2,394 |
2,322 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,802 |
2,776 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,240 |
2,194 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,977 |
2,926 |
$50K |
| D1120 |
Prophylaxis - child |
1,525 |
1,516 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
979 |
901 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
617 |
577 |
$22K |
| D2332 |
|
108 |
44 |
$12K |
| D2394 |
|
75 |
54 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
176 |
$5K |
| D4341 |
|
113 |
51 |
$3K |
| D3120 |
|
118 |
61 |
$2K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
74 |
$1K |
| D9994 |
|
262 |
261 |
$0.00 |