| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,717 |
3,111 |
$353K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,057 |
2,282 |
$236K |
| D1110 |
Prophylaxis - adult |
4,697 |
4,527 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,094 |
6,835 |
$180K |
| D0330 |
Panoramic radiographic image |
4,555 |
4,370 |
$162K |
| D0274 |
Bitewings - four radiographic images |
5,717 |
5,489 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,519 |
1,464 |
$100K |
| D2332 |
|
1,488 |
842 |
$88K |
| D2335 |
|
1,176 |
524 |
$84K |
| D2331 |
|
1,289 |
860 |
$65K |
| D2394 |
|
485 |
337 |
$33K |
| D1120 |
Prophylaxis - child |
642 |
623 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
555 |
242 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,298 |
1,262 |
$20K |
| D2330 |
|
389 |
250 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,803 |
2,652 |
$15K |
| D2160 |
|
218 |
124 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
222 |
220 |
$6K |
| D0272 |
Bitewings - two radiographic images |
204 |
200 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
744 |
504 |
$3K |
| D9110 |
|
62 |
61 |
$1K |
| D2140 |
|
24 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
27 |
$902.16 |
| D9986 |
|
1,151 |
1,015 |
$246.00 |