| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,639 |
568 |
$222K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,158 |
482 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
613 |
363 |
$104K |
| D1110 |
Prophylaxis - adult |
996 |
984 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
923 |
913 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,062 |
1,049 |
$33K |
| D1120 |
Prophylaxis - child |
706 |
695 |
$33K |
| D0330 |
Panoramic radiographic image |
699 |
697 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
907 |
889 |
$21K |
| D0274 |
Bitewings - four radiographic images |
876 |
863 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
404 |
372 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,372 |
1,076 |
$15K |
| D2750 |
|
26 |
12 |
$11K |
| D3120 |
|
237 |
105 |
$8K |
| D2330 |
|
53 |
15 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
491 |
474 |
$5K |
| D2335 |
|
26 |
13 |
$5K |
| D2332 |
|
31 |
14 |
$4K |
| D1330 |
|
220 |
215 |
$1K |
| D2951 |
|
96 |
58 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
24 |
$393.84 |