| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,089 |
1,407 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
5,016 |
4,980 |
$134K |
| D2335 |
|
1,457 |
608 |
$100K |
| D1110 |
Prophylaxis - adult |
4,296 |
4,269 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,037 |
4,804 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,457 |
520 |
$61K |
| D2332 |
|
753 |
400 |
$43K |
| D2750 |
|
97 |
80 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
5,367 |
5,292 |
$21K |
| D1120 |
Prophylaxis - child |
992 |
986 |
$21K |
| D2394 |
|
328 |
187 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,247 |
1,240 |
$19K |
| D0274 |
Bitewings - four radiographic images |
2,191 |
2,174 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,431 |
1,422 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
391 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
301 |
301 |
$9K |
| D4341 |
|
208 |
75 |
$9K |
| D0272 |
Bitewings - two radiographic images |
2,118 |
2,105 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
313 |
308 |
$7K |
| D1351 |
Sealant - per tooth |
386 |
48 |
$4K |
| D2330 |
|
106 |
43 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
45 |
$3K |
| D2160 |
|
39 |
21 |
$2K |
| D2161 |
|
22 |
16 |
$1K |
| D2950 |
|
16 |
12 |
$810.00 |