| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
2,675 |
1,895 |
$244K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,181 |
2,090 |
$227K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,705 |
1,478 |
$93K |
| D1110 |
Prophylaxis - adult |
2,462 |
2,460 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
4,072 |
4,071 |
$84K |
| D1120 |
Prophylaxis - child |
1,487 |
1,487 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,009 |
3,998 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,035 |
2,035 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,502 |
3,499 |
$38K |
| D2394 |
|
450 |
305 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,559 |
2,558 |
$28K |
| D2332 |
|
293 |
258 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
1,264 |
1,255 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
248 |
234 |
$8K |
| D1351 |
Sealant - per tooth |
72 |
65 |
$7K |
| D4341 |
|
59 |
25 |
$3K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$703.50 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
42 |
$428.36 |