| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,406 |
2,851 |
$1.22M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,017 |
2,426 |
$803K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,128 |
1,060 |
$279K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,208 |
3,112 |
$133K |
| D1110 |
Prophylaxis - adult |
3,083 |
3,032 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
1,603 |
1,572 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,219 |
3,438 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
4,006 |
3,905 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,944 |
1,901 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,421 |
1,393 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,020 |
1,000 |
$35K |
| D2330 |
|
231 |
111 |
$15K |
| D1206 |
Topical application of fluoride varnish |
632 |
619 |
$10K |
| D0272 |
Bitewings - two radiographic images |
411 |
405 |
$7K |
| D4341 |
|
68 |
28 |
$6K |
| D2394 |
|
36 |
26 |
$6K |
| D2331 |
|
72 |
39 |
$6K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$640.32 |