| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,602 |
955 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,645 |
652 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,557 |
4,470 |
$116K |
| D1110 |
Prophylaxis - adult |
1,998 |
1,955 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,405 |
4,372 |
$74K |
| D1120 |
Prophylaxis - child |
2,655 |
2,607 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,405 |
2,338 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,955 |
2,873 |
$25K |
| D4341 |
|
516 |
125 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
481 |
457 |
$19K |
| D1206 |
Topical application of fluoride varnish |
794 |
709 |
$18K |
| D0330 |
Panoramic radiographic image |
445 |
441 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,024 |
2,711 |
$7K |
| D1999 |
|
827 |
779 |
$7K |
| D9920 |
|
135 |
132 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
159 |
157 |
$3K |
| D2332 |
|
37 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$133.77 |