| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,438 |
621 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,291 |
494 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,588 |
2,335 |
$71K |
| D1110 |
Prophylaxis - adult |
1,806 |
1,768 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,933 |
1,921 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,298 |
1,277 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,652 |
1,619 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
285 |
181 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
269 |
267 |
$16K |
| D2332 |
|
96 |
51 |
$10K |
| D1120 |
Prophylaxis - child |
199 |
199 |
$9K |
| D2394 |
|
69 |
52 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
475 |
463 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
70 |
$3K |
| D2330 |
|
16 |
13 |
$887.68 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
25 |
$434.69 |