| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,234 |
570 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
547 |
325 |
$35K |
| D1110 |
Prophylaxis - adult |
992 |
987 |
$34K |
| D0330 |
Panoramic radiographic image |
901 |
893 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,105 |
1,096 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,098 |
1,087 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
879 |
871 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
219 |
$16K |
| D2335 |
|
142 |
81 |
$9K |
| D1206 |
Topical application of fluoride varnish |
448 |
438 |
$8K |
| D1120 |
Prophylaxis - child |
231 |
228 |
$7K |
| D1330 |
|
338 |
338 |
$4K |
| D1310 |
|
340 |
340 |
$4K |
| D2332 |
|
63 |
40 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
557 |
540 |
$3K |
| D2330 |
|
39 |
24 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
14 |
14 |
$2K |
| D2394 |
|
21 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
69 |
65 |
$1K |
| D2331 |
|
18 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
70 |
$730.92 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$479.00 |
| D9110 |
|
13 |
12 |
$392.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$224.04 |