| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2722 |
|
117 |
62 |
$103K |
| D2991 |
|
233 |
51 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
79 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
481 |
384 |
$21K |
| D0330 |
Panoramic radiographic image |
325 |
262 |
$19K |
| D2950 |
|
110 |
56 |
$18K |
| D1110 |
Prophylaxis - adult |
298 |
238 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
183 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
221 |
79 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
228 |
$8K |
| D1351 |
Sealant - per tooth |
209 |
35 |
$7K |
| D1120 |
Prophylaxis - child |
179 |
138 |
$7K |
| D1206 |
Topical application of fluoride varnish |
163 |
125 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
51 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
54 |
35 |
$2K |
| D0274 |
Bitewings - four radiographic images |
22 |
22 |
$1K |