| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
521 |
396 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
606 |
598 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
703 |
696 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
429 |
416 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
210 |
$3K |
| D1206 |
Topical application of fluoride varnish |
811 |
792 |
$3K |
| D1110 |
Prophylaxis - adult |
299 |
294 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
880 |
825 |
$2K |
| D4341 |
|
105 |
79 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
78 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,418 |
414 |
$1K |
| D0603 |
|
553 |
546 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
421 |
417 |
$1K |
| D0274 |
Bitewings - four radiographic images |
270 |
266 |
$783.00 |
| D0330 |
Panoramic radiographic image |
236 |
230 |
$780.00 |
| D1120 |
Prophylaxis - child |
82 |
79 |
$720.00 |
| D2394 |
|
14 |
14 |
$485.00 |
| D0270 |
|
199 |
194 |
$431.20 |
| D0602 |
|
182 |
178 |
$308.00 |
| D1320 |
|
117 |
117 |
$290.00 |
| D1354 |
|
257 |
96 |
$148.00 |
| D0601 |
|
43 |
43 |
$121.00 |
| D1310 |
|
1,147 |
1,097 |
$80.00 |
| D4910 |
|
12 |
12 |
$70.00 |
| D1330 |
|
1,161 |
1,108 |
$50.00 |