| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,683 |
473 |
$220K |
| D1206 |
Topical application of fluoride varnish |
2,963 |
2,927 |
$74K |
| D1110 |
Prophylaxis - adult |
1,127 |
1,110 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
634 |
206 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,933 |
1,918 |
$58K |
| D1120 |
Prophylaxis - child |
1,291 |
1,280 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
745 |
729 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
516 |
497 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,823 |
1,747 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
347 |
$17K |
| D0274 |
Bitewings - four radiographic images |
688 |
685 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
34 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,435 |
1,404 |
$9K |
| D1330 |
|
1,003 |
997 |
$6K |
| D0330 |
Panoramic radiographic image |
93 |
93 |
$4K |
| D2394 |
|
23 |
14 |
$4K |
| D0272 |
Bitewings - two radiographic images |
139 |
139 |
$2K |