| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,886 |
751 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,170 |
562 |
$67K |
| D1110 |
Prophylaxis - adult |
828 |
824 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,432 |
1,431 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,403 |
1,400 |
$21K |
| D1120 |
Prophylaxis - child |
547 |
547 |
$15K |
| D0274 |
Bitewings - four radiographic images |
760 |
755 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
77 |
42 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
155 |
91 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
553 |
522 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
294 |
286 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
971 |
800 |
$7K |
| D2335 |
|
31 |
13 |
$5K |
| D2332 |
|
23 |
13 |
$3K |
| D2394 |
|
16 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
52 |
$0.00 |