| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,396 |
713 |
$186K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,943 |
2,848 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,560 |
685 |
$130K |
| D1110 |
Prophylaxis - adult |
1,841 |
1,834 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,257 |
1,244 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
250 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,688 |
1,683 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,265 |
3,117 |
$43K |
| D4355 |
|
347 |
346 |
$24K |
| D0274 |
Bitewings - four radiographic images |
350 |
350 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
249 |
$4K |
| D2332 |
|
40 |
24 |
$4K |
| D2394 |
|
19 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
63 |
$2K |