| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,690 |
772 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
504 |
282 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
241 |
164 |
$32K |
| D1110 |
Prophylaxis - adult |
248 |
243 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
172 |
$7K |
| D2332 |
|
80 |
40 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
225 |
219 |
$5K |
| D9110 |
|
115 |
107 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
55 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
145 |
136 |
$2K |
| D2330 |
|
16 |
12 |
$1K |
| D4355 |
|
12 |
12 |
$842.28 |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
49 |
$780.98 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$402.60 |