| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,155 |
2,438 |
$373K |
| D1120 |
Prophylaxis - child |
5,057 |
5,043 |
$223K |
| D1206 |
Topical application of fluoride varnish |
8,865 |
8,811 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,801 |
5,771 |
$156K |
| D1110 |
Prophylaxis - adult |
4,103 |
4,063 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,164 |
2,102 |
$108K |
| D0330 |
Panoramic radiographic image |
1,183 |
1,181 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
1,648 |
1,628 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
863 |
611 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,631 |
2,608 |
$92K |
| D0272 |
Bitewings - two radiographic images |
2,503 |
2,498 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
840 |
549 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
28 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
79 |
$3K |
| D2394 |
|
16 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$1K |
| D9986 |
|
26 |
24 |
$0.00 |
| D9987 |
|
19 |
19 |
$0.00 |