| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
274 |
94 |
$17K |
| D1110 |
Prophylaxis - adult |
388 |
364 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
70 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
487 |
454 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
149 |
81 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
117 |
$7K |
| D0274 |
Bitewings - four radiographic images |
316 |
292 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
372 |
347 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
175 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
502 |
458 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
464 |
345 |
$2K |
| D1120 |
Prophylaxis - child |
111 |
104 |
$2K |
| D1351 |
Sealant - per tooth |
61 |
14 |
$1K |
| D2330 |
|
62 |
31 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D2331 |
|
55 |
36 |
$634.90 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$361.28 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$120.00 |