| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,205 |
989 |
$215K |
| D1110 |
Prophylaxis - adult |
1,432 |
1,431 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,100 |
1,100 |
$72K |
| D0350 |
|
6,785 |
1,765 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
975 |
389 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,076 |
1,076 |
$51K |
| D2330 |
|
397 |
162 |
$30K |
| D9110 |
|
457 |
439 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
457 |
457 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,571 |
1,571 |
$27K |
| D1320 |
|
1,155 |
1,153 |
$17K |
| D0274 |
Bitewings - four radiographic images |
395 |
395 |
$9K |
| D9430 |
|
263 |
245 |
$8K |
| D5660 |
|
60 |
25 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,527 |
970 |
$6K |
| D5650 |
|
59 |
25 |
$5K |
| D0270 |
|
184 |
178 |
$918.75 |