| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,293 |
879 |
$718K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,636 |
875 |
$390K |
| D4210 |
|
444 |
190 |
$107K |
| D0274 |
Bitewings - four radiographic images |
2,477 |
2,411 |
$98K |
| D1110 |
Prophylaxis - adult |
1,592 |
1,539 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,464 |
1,413 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,965 |
1,935 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,580 |
2,508 |
$46K |
| D1120 |
Prophylaxis - child |
939 |
922 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,703 |
2,479 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,195 |
1,171 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
132 |
$5K |