| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,910 |
1,257 |
$152K |
| D1110 |
Prophylaxis - adult |
1,505 |
1,489 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,368 |
1,351 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,011 |
638 |
$27K |
| D0330 |
Panoramic radiographic image |
1,248 |
1,233 |
$13K |
| D2332 |
|
508 |
214 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
233 |
231 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
852 |
844 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,979 |
1,960 |
$6K |
| D1330 |
|
2,501 |
2,326 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,344 |
1,305 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,437 |
2,205 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
284 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
78 |
$2K |
| D1120 |
Prophylaxis - child |
84 |
84 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,282 |
2,225 |
$688.97 |
| D4355 |
|
12 |
12 |
$390.38 |
| D0350 |
|
924 |
914 |
$288.20 |
| D3120 |
|
42 |
14 |
$0.00 |