| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
823 |
503 |
$86K |
| D1110 |
Prophylaxis - adult |
1,372 |
1,321 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
320 |
222 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
820 |
781 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
824 |
785 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
908 |
882 |
$22K |
| D0274 |
Bitewings - four radiographic images |
565 |
546 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,070 |
997 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
246 |
241 |
$15K |
| D2335 |
|
69 |
39 |
$8K |
| D0160 |
|
90 |
88 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
328 |
139 |
$4K |
| D2332 |
|
39 |
25 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
29 |
$3K |
| D1120 |
Prophylaxis - child |
101 |
99 |
$3K |
| D2394 |
|
16 |
14 |
$3K |
| D0330 |
Panoramic radiographic image |
50 |
49 |
$3K |
| D1206 |
Topical application of fluoride varnish |
147 |
141 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
123 |
118 |
$2K |