| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,547 |
1,282 |
$153K |
| D1110 |
Prophylaxis - adult |
4,142 |
3,576 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,757 |
4,255 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,663 |
2,221 |
$81K |
| D1120 |
Prophylaxis - child |
2,056 |
1,931 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,996 |
2,699 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,723 |
3,376 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,317 |
774 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,544 |
1,241 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
4,105 |
3,418 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,654 |
2,517 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
822 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
52 |
$5K |
| D0330 |
Panoramic radiographic image |
56 |
42 |
$2K |
| D0272 |
Bitewings - two radiographic images |
16 |
14 |
$378.24 |
| D0270 |
|
33 |
30 |
$141.96 |
| D1999 |
|
1,305 |
1,056 |
$0.00 |