| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,140 |
1,425 |
$201K |
| D1110 |
Prophylaxis - adult |
4,464 |
3,971 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,725 |
4,330 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,714 |
3,320 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,802 |
2,190 |
$80K |
| D1120 |
Prophylaxis - child |
1,942 |
1,800 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
889 |
471 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
2,514 |
2,169 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,265 |
2,155 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
881 |
442 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
922 |
768 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,881 |
1,693 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,057 |
2,618 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,396 |
842 |
$12K |
| D2335 |
|
28 |
12 |
$3K |
| D1330 |
|
20 |
19 |
$0.00 |
| D1310 |
|
26 |
20 |
$0.00 |