| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,508 |
966 |
$91K |
| D0330 |
Panoramic radiographic image |
2,177 |
1,618 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,409 |
1,421 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,158 |
1,708 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
437 |
350 |
$12K |
| D2332 |
|
189 |
67 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$8K |
| D2330 |
|
245 |
96 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
483 |
378 |
$1K |
| D1330 |
|
720 |
549 |
$796.95 |
| D0272 |
Bitewings - two radiographic images |
229 |
214 |
$788.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
577 |
451 |
$697.10 |
| D4355 |
|
13 |
13 |
$208.92 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
17 |
$28.14 |