| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,391 |
1,075 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,929 |
861 |
$36K |
| D1110 |
Prophylaxis - adult |
3,137 |
3,093 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,055 |
2,026 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
2,096 |
2,060 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
1,285 |
1,260 |
$17K |
| D2750 |
|
74 |
54 |
$12K |
| D2394 |
|
245 |
156 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,610 |
1,586 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
2,948 |
2,858 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,553 |
2,487 |
$4K |
| D1120 |
Prophylaxis - child |
446 |
438 |
$3K |
| D4341 |
|
105 |
36 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
251 |
243 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
60 |
$2K |
| D2335 |
|
43 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
306 |
292 |
$1K |
| D2950 |
|
46 |
25 |
$950.00 |
| D1206 |
Topical application of fluoride varnish |
69 |
59 |
$577.50 |
| D0272 |
Bitewings - two radiographic images |
167 |
161 |
$545.00 |
| D9110 |
|
13 |
13 |
$60.00 |
| D0270 |
|
12 |
12 |
$21.00 |