| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,170 |
1,556 |
$396K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,894 |
1,152 |
$273K |
| D1110 |
Prophylaxis - adult |
3,784 |
3,383 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
4,836 |
4,366 |
$142K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
866 |
442 |
$127K |
| D1120 |
Prophylaxis - child |
2,871 |
2,592 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,310 |
2,984 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,582 |
1,434 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,107 |
995 |
$38K |
| D2332 |
|
163 |
43 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
217 |
203 |
$17K |
| D0272 |
Bitewings - two radiographic images |
488 |
427 |
$10K |
| D0330 |
Panoramic radiographic image |
189 |
162 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
382 |
319 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
80 |
$3K |
| D1351 |
Sealant - per tooth |
49 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
26 |
$636.39 |
| D1999 |
|
384 |
345 |
$0.00 |