| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,606 |
933 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
899 |
536 |
$50K |
| D1110 |
Prophylaxis - adult |
991 |
904 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,521 |
1,377 |
$33K |
| D0274 |
Bitewings - four radiographic images |
904 |
812 |
$20K |
| D2394 |
|
186 |
125 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
898 |
812 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
263 |
180 |
$10K |
| D1120 |
Prophylaxis - child |
239 |
205 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
534 |
470 |
$4K |
| D0330 |
Panoramic radiographic image |
80 |
73 |
$3K |
| D9110 |
|
94 |
82 |
$2K |
| D2332 |
|
16 |
12 |
$1K |
| D2331 |
|
24 |
14 |
$895.95 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
13 |
$114.72 |
| D9986 |
|
42 |
34 |
$0.00 |