| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
457 |
122 |
$29K |
| D2332 |
|
98 |
45 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
41 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
47 |
$7K |
| D2335 |
|
60 |
34 |
$7K |
| D1110 |
Prophylaxis - adult |
247 |
235 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
255 |
246 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
104 |
52 |
$6K |
| D2160 |
|
79 |
43 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
342 |
339 |
$6K |
| D0274 |
Bitewings - four radiographic images |
198 |
197 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
486 |
165 |
$5K |
| D2140 |
|
102 |
43 |
$5K |
| D2394 |
|
25 |
16 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
219 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
59 |
57 |
$2K |
| D2330 |
|
37 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
118 |
117 |
$2K |
| D1120 |
Prophylaxis - child |
27 |
26 |
$1K |