| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
1,395 |
725 |
$270K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,277 |
781 |
$211K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
937 |
551 |
$126K |
| D1110 |
Prophylaxis - adult |
1,651 |
1,641 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,910 |
1,903 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
877 |
$35K |
| D3910 |
|
361 |
83 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,065 |
1,063 |
$32K |
| D0350 |
|
904 |
898 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
349 |
347 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,915 |
1,872 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,150 |
1,145 |
$15K |
| D1206 |
Topical application of fluoride varnish |
493 |
488 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
238 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
52 |
$8K |
| D4342 |
|
84 |
31 |
$8K |
| D4910 |
|
109 |
109 |
$7K |
| D0460 |
|
15 |
13 |
$407.82 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$386.88 |