| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,120 |
487 |
$224K |
| D7510 |
|
806 |
691 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
1,652 |
1,429 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,043 |
242 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,842 |
1,142 |
$35K |
| D1110 |
Prophylaxis - adult |
809 |
795 |
$31K |
| D2332 |
|
319 |
128 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
233 |
109 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,588 |
1,417 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
849 |
836 |
$21K |
| D2335 |
|
161 |
68 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
784 |
768 |
$13K |
| D0274 |
Bitewings - four radiographic images |
187 |
185 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
114 |
$5K |
| D1120 |
Prophylaxis - child |
79 |
79 |
$2K |
| D4355 |
|
16 |
16 |
$1K |
| D9110 |
|
22 |
14 |
$667.80 |
| D1999 |
|
14 |
13 |
$0.00 |