| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,057 |
597 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
625 |
347 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,542 |
1,474 |
$37K |
| D1110 |
Prophylaxis - adult |
904 |
882 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,368 |
984 |
$23K |
| D1120 |
Prophylaxis - child |
860 |
840 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,406 |
1,339 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,259 |
1,154 |
$17K |
| D0274 |
Bitewings - four radiographic images |
349 |
329 |
$10K |
| D0330 |
Panoramic radiographic image |
222 |
201 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
198 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
27 |
$5K |
| D0272 |
Bitewings - two radiographic images |
180 |
168 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
46 |
$2K |
| D2332 |
|
19 |
12 |
$1K |