| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,755 |
1,775 |
$200K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,358 |
1,615 |
$191K |
| D1110 |
Prophylaxis - adult |
3,300 |
3,169 |
$110K |
| D4341 |
|
2,942 |
717 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,637 |
2,521 |
$81K |
| D0330 |
Panoramic radiographic image |
2,703 |
2,599 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,631 |
3,548 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,839 |
4,682 |
$61K |
| D0274 |
Bitewings - four radiographic images |
4,380 |
4,239 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,454 |
2,173 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
656 |
417 |
$45K |
| D2332 |
|
678 |
327 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
5,179 |
4,788 |
$38K |
| D1120 |
Prophylaxis - child |
1,529 |
1,490 |
$33K |
| D9630 |
|
504 |
490 |
$21K |
| D1206 |
Topical application of fluoride varnish |
888 |
866 |
$21K |
| D1351 |
Sealant - per tooth |
603 |
142 |
$11K |
| D2331 |
|
185 |
95 |
$9K |
| D2330 |
|
209 |
124 |
$8K |
| D1999 |
|
881 |
783 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,217 |
2,251 |
$6K |
| D4346 |
|
130 |
126 |
$4K |
| D2335 |
|
70 |
43 |
$4K |
| D4910 |
|
97 |
95 |
$4K |
| D9110 |
|
40 |
39 |
$2K |
| D9920 |
|
14 |
13 |
$361.16 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$248.22 |