| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,561 |
1,072 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
816 |
612 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
2,931 |
2,858 |
$62K |
| D1110 |
Prophylaxis - adult |
1,363 |
1,331 |
$62K |
| D1120 |
Prophylaxis - child |
2,000 |
1,950 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,029 |
2,844 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,212 |
2,130 |
$40K |
| D0330 |
Panoramic radiographic image |
778 |
757 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,077 |
1,051 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,554 |
2,106 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,165 |
1,165 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
220 |
$16K |
| D0272 |
Bitewings - two radiographic images |
743 |
724 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
411 |
399 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
274 |
274 |
$8K |
| D0603 |
|
604 |
553 |
$6K |
| D0602 |
|
427 |
415 |
$4K |
| D0240 |
|
103 |
63 |
$2K |
| D3120 |
|
38 |
25 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$793.00 |
| D0601 |
|
25 |
25 |
$228.75 |