| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,649 |
1,839 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,758 |
3,758 |
$75K |
| D1110 |
Prophylaxis - adult |
2,093 |
2,093 |
$41K |
| D1120 |
Prophylaxis - child |
1,645 |
1,645 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
795 |
664 |
$29K |
| D0274 |
Bitewings - four radiographic images |
2,289 |
2,289 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,288 |
2,276 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
619 |
608 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,958 |
2,940 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,369 |
1,369 |
$8K |
| D0272 |
Bitewings - two radiographic images |
902 |
902 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
73 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
106 |
$2K |
| D2331 |
|
38 |
32 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
31 |
$1K |
| D0270 |
|
153 |
153 |
$453.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$260.00 |
| D1999 |
|
14 |
13 |
$0.00 |