| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,494 |
432 |
$298K |
| D2330 |
|
4,594 |
399 |
$165K |
| D4341 |
|
3,205 |
804 |
$103K |
| D0330 |
Panoramic radiographic image |
2,004 |
1,911 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,818 |
1,734 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,141 |
338 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,179 |
2,094 |
$34K |
| D9110 |
|
223 |
217 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,595 |
1,523 |
$16K |
| D1110 |
Prophylaxis - adult |
469 |
452 |
$15K |
| D2140 |
|
149 |
13 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
618 |
572 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
170 |
165 |
$3K |
| D4342 |
|
144 |
60 |
$3K |
| D1999 |
|
129 |
105 |
$2K |
| D1120 |
Prophylaxis - child |
53 |
51 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
316 |
298 |
$727.20 |
| D9920 |
|
52 |
50 |
$690.08 |
| D9999 |
Unspecified adjunctive procedure, by report |
52 |
50 |
$413.70 |