| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,293 |
691 |
$84K |
| D1110 |
Prophylaxis - adult |
806 |
777 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
884 |
856 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
606 |
594 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
189 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
771 |
418 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,156 |
1,117 |
$9K |
| D3120 |
|
152 |
85 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
296 |
275 |
$5K |
| D1120 |
Prophylaxis - child |
623 |
607 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,126 |
1,294 |
$4K |
| D1330 |
|
1,294 |
1,257 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
46 |
46 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,551 |
1,486 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,207 |
1,171 |
$2K |
| D1999 |
|
24 |
24 |
$960.00 |
| D2332 |
|
14 |
12 |
$919.92 |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
42 |
$682.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$137.20 |
| D0602 |
|
42 |
27 |
$14.00 |
| D0601 |
|
349 |
331 |
$12.00 |
| D0603 |
|
25 |
25 |
$0.00 |