| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,464 |
1,340 |
$121K |
| D1110 |
Prophylaxis - adult |
2,963 |
2,891 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,379 |
903 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
3,988 |
3,904 |
$65K |
| D2335 |
|
523 |
269 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
834 |
796 |
$41K |
| D1320 |
|
2,789 |
2,739 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
772 |
485 |
$37K |
| D1120 |
Prophylaxis - child |
1,892 |
1,855 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,478 |
2,433 |
$36K |
| D2332 |
|
596 |
349 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,403 |
1,372 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
964 |
934 |
$24K |
| D2394 |
|
318 |
237 |
$22K |
| D1351 |
Sealant - per tooth |
531 |
138 |
$11K |
| D2331 |
|
207 |
143 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
157 |
82 |
$8K |
| D0272 |
Bitewings - two radiographic images |
801 |
779 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,627 |
1,548 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
299 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
813 |
485 |
$4K |
| D2160 |
|
24 |
16 |
$2K |
| D2140 |
|
33 |
20 |
$1K |
| D2330 |
|
24 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
16 |
15 |
$165.00 |