| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,190 |
586 |
$89K |
| D1110 |
Prophylaxis - adult |
1,669 |
1,581 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,783 |
1,697 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,847 |
1,758 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
982 |
913 |
$40K |
| D0330 |
Panoramic radiographic image |
1,265 |
1,164 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,734 |
1,657 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
447 |
214 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
395 |
180 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
973 |
899 |
$27K |
| D1120 |
Prophylaxis - child |
826 |
786 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
519 |
456 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,313 |
1,162 |
$13K |
| D0240 |
|
858 |
417 |
$12K |
| D0270 |
|
283 |
257 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
92 |
$532.75 |
| D1999 |
|
25 |
15 |
$0.00 |