| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,624 |
1,380 |
$209K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,401 |
622 |
$60K |
| D1110 |
Prophylaxis - adult |
1,133 |
1,098 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,634 |
1,572 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
540 |
328 |
$32K |
| D1120 |
Prophylaxis - child |
556 |
550 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
510 |
492 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,512 |
1,467 |
$23K |
| D0330 |
Panoramic radiographic image |
326 |
320 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
423 |
412 |
$10K |
| D0274 |
Bitewings - four radiographic images |
345 |
341 |
$8K |
| D2394 |
|
111 |
62 |
$6K |
| D0272 |
Bitewings - two radiographic images |
41 |
40 |
$719.65 |
| D9987 |
|
56 |
45 |
$6.00 |
| D9986 |
|
43 |
36 |
$6.00 |