| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,477 |
1,816 |
$245K |
| D1110 |
Prophylaxis - adult |
4,959 |
4,646 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
5,477 |
5,205 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
2,044 |
1,889 |
$109K |
| D0274 |
Bitewings - four radiographic images |
3,326 |
3,161 |
$106K |
| D1120 |
Prophylaxis - child |
2,439 |
2,353 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,005 |
635 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,208 |
694 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,727 |
1,594 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,203 |
2,127 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,483 |
4,153 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,970 |
3,223 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,145 |
1,033 |
$31K |
| D2331 |
|
197 |
110 |
$16K |
| D2791 |
|
29 |
25 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
128 |
88 |
$7K |
| D2394 |
|
32 |
25 |
$3K |
| D1206 |
Topical application of fluoride varnish |
199 |
183 |
$3K |
| D2330 |
|
18 |
12 |
$1K |