| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2940 |
|
16,984 |
1,521 |
$637K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,909 |
729 |
$241K |
| D2394 |
|
1,180 |
430 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
661 |
344 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,603 |
2,554 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
702 |
288 |
$57K |
| D1110 |
Prophylaxis - adult |
1,303 |
1,271 |
$48K |
| D1120 |
Prophylaxis - child |
1,547 |
1,521 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,515 |
2,459 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,010 |
981 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
762 |
716 |
$27K |
| D9110 |
|
620 |
575 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,093 |
1,206 |
$25K |
| D0330 |
Panoramic radiographic image |
431 |
422 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,402 |
1,343 |
$20K |
| D0272 |
Bitewings - two radiographic images |
508 |
494 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
182 |
$8K |
| D4355 |
|
90 |
87 |
$6K |
| D1999 |
|
621 |
546 |
$0.00 |