| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,231 |
3,170 |
$325K |
| D1110 |
Prophylaxis - adult |
4,827 |
4,823 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,367 |
2,715 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
4,827 |
4,822 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,826 |
4,825 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
6,164 |
6,151 |
$58K |
| D2331 |
|
997 |
721 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,828 |
5,821 |
$32K |
| D2332 |
|
395 |
327 |
$28K |
| D2330 |
|
365 |
334 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
71 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
295 |
$6K |
| D1120 |
Prophylaxis - child |
151 |
150 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
282 |
281 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
187 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
144 |
$1K |
| D2335 |
|
16 |
13 |
$1K |