| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,149 |
1,003 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,697 |
770 |
$137K |
| D2332 |
|
738 |
359 |
$80K |
| D2335 |
|
358 |
209 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,418 |
1,852 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,210 |
2,092 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,700 |
1,596 |
$48K |
| D1110 |
Prophylaxis - adult |
1,415 |
1,348 |
$41K |
| D0330 |
Panoramic radiographic image |
1,153 |
865 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,703 |
1,633 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
507 |
251 |
$29K |
| D1120 |
Prophylaxis - child |
665 |
648 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,531 |
2,297 |
$27K |
| D2330 |
|
317 |
177 |
$18K |
| D2140 |
|
257 |
117 |
$12K |
| D2331 |
|
177 |
70 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
144 |
$7K |
| D7971 |
|
44 |
39 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
105 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$2K |