| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,285 |
693 |
$76K |
| D1110 |
Prophylaxis - adult |
1,406 |
1,389 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,718 |
1,707 |
$44K |
| D1120 |
Prophylaxis - child |
708 |
705 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
370 |
261 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
523 |
502 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
216 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
693 |
692 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,212 |
1,196 |
$15K |
| D2750 |
|
22 |
14 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,360 |
2,284 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
365 |
363 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,977 |
1,944 |
$9K |
| D0330 |
Panoramic radiographic image |
193 |
193 |
$8K |
| D2954 |
|
43 |
30 |
$4K |
| D0272 |
Bitewings - two radiographic images |
217 |
216 |
$2K |
| D2330 |
|
29 |
15 |
$1K |