| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
850 |
420 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,832 |
1,773 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
735 |
343 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,921 |
1,866 |
$48K |
| D1120 |
Prophylaxis - child |
1,074 |
1,054 |
$46K |
| D1110 |
Prophylaxis - adult |
1,214 |
1,175 |
$39K |
| D2394 |
|
333 |
170 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
787 |
729 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
532 |
444 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,582 |
1,390 |
$15K |
| D0330 |
Panoramic radiographic image |
363 |
253 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
539 |
534 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
258 |
107 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
886 |
420 |
$8K |
| D2332 |
|
85 |
36 |
$8K |
| D1206 |
Topical application of fluoride varnish |
231 |
224 |
$5K |
| D2335 |
|
21 |
16 |
$3K |