| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,217 |
747 |
$119K |
| D1110 |
Prophylaxis - adult |
1,842 |
1,842 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,729 |
2,729 |
$75K |
| D0330 |
Panoramic radiographic image |
1,328 |
1,326 |
$66K |
| D1120 |
Prophylaxis - child |
1,836 |
1,836 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,401 |
1,401 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,414 |
2,414 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
322 |
236 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,073 |
2,073 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
865 |
856 |
$32K |
| D1206 |
Topical application of fluoride varnish |
796 |
796 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
989 |
966 |
$12K |
| D9310 |
|
107 |
107 |
$7K |
| D2394 |
|
18 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
24 |
$2K |