| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,263 |
1,659 |
$159K |
| D1110 |
Prophylaxis - adult |
3,307 |
3,190 |
$110K |
| D2330 |
|
1,756 |
793 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
4,519 |
4,407 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
2,551 |
2,420 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,497 |
3,430 |
$52K |
| D1120 |
Prophylaxis - child |
2,549 |
2,484 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,509 |
2,430 |
$49K |
| D0330 |
Panoramic radiographic image |
1,094 |
1,049 |
$46K |
| D2331 |
|
511 |
344 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
860 |
825 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,701 |
1,666 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
124 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,361 |
1,292 |
$7K |
| D1320 |
|
166 |
149 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
296 |
288 |
$2K |
| D2140 |
|
22 |
12 |
$753.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12 |
12 |
$681.72 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$402.16 |
| D1330 |
|
227 |
215 |
$0.00 |