| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
948 |
544 |
$110K |
| D1110 |
Prophylaxis - adult |
2,474 |
2,116 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,916 |
2,509 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,719 |
2,569 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,784 |
3,042 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,350 |
1,171 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,480 |
1,286 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
338 |
212 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,821 |
1,603 |
$25K |
| D1120 |
Prophylaxis - child |
636 |
604 |
$15K |
| D0330 |
Panoramic radiographic image |
239 |
226 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
221 |
$9K |
| D2394 |
|
15 |
12 |
$2K |
| D4355 |
|
12 |
12 |
$704.44 |
| D0272 |
Bitewings - two radiographic images |
28 |
27 |
$439.75 |