| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,533 |
1,142 |
$343K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,576 |
969 |
$262K |
| D2394 |
|
822 |
390 |
$97K |
| D2332 |
|
814 |
347 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,016 |
460 |
$69K |
| D2335 |
|
516 |
205 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,060 |
1,491 |
$50K |
| D2160 |
|
605 |
260 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,377 |
1,330 |
$41K |
| D2331 |
|
453 |
257 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,584 |
1,533 |
$30K |
| D1110 |
Prophylaxis - adult |
887 |
860 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
452 |
220 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,046 |
1,019 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,624 |
1,558 |
$19K |
| D2330 |
|
249 |
162 |
$15K |
| D1120 |
Prophylaxis - child |
332 |
329 |
$15K |
| D7971 |
|
67 |
63 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
220 |
$11K |
| D1351 |
Sealant - per tooth |
64 |
20 |
$3K |
| D2161 |
|
24 |
18 |
$2K |
| D2140 |
|
36 |
26 |
$2K |