| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,480 |
825 |
$99K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,075 |
672 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,509 |
1,495 |
$79K |
| D1110 |
Prophylaxis - adult |
800 |
793 |
$65K |
| D1120 |
Prophylaxis - child |
1,008 |
999 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,011 |
2,004 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,697 |
1,413 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
287 |
287 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
168 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
250 |
244 |
$11K |
| D9430 |
|
319 |
302 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
696 |
685 |
$8K |
| D4910 |
|
40 |
40 |
$3K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$144.00 |
| D1999 |
|
231 |
230 |
$96.00 |