| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,131 |
982 |
$868K |
| D2332 |
|
1,336 |
411 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,016 |
274 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
1,111 |
893 |
$52K |
| D1110 |
Prophylaxis - adult |
788 |
778 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
711 |
701 |
$39K |
| D0330 |
Panoramic radiographic image |
670 |
662 |
$30K |
| D0274 |
Bitewings - four radiographic images |
807 |
793 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
317 |
314 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
542 |
459 |
$6K |
| D1206 |
Topical application of fluoride varnish |
121 |
120 |
$3K |
| D2330 |
|
22 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
77 |
65 |
$530.24 |
| D1330 |
|
12 |
12 |
$86.40 |