| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,640 |
860 |
$168K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
726 |
407 |
$89K |
| D1110 |
Prophylaxis - adult |
2,180 |
1,985 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,880 |
1,574 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,081 |
1,893 |
$45K |
| D0330 |
Panoramic radiographic image |
687 |
619 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
825 |
751 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,348 |
2,047 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,119 |
966 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
183 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,728 |
1,175 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
643 |
632 |
$11K |
| D1120 |
Prophylaxis - child |
259 |
246 |
$7K |
| D1206 |
Topical application of fluoride varnish |
398 |
351 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
29 |
$2K |
| D4355 |
|
15 |
13 |
$961.61 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$264.16 |