| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,160 |
742 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,126 |
754 |
$82K |
| D2332 |
|
710 |
426 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,077 |
605 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,632 |
1,506 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,285 |
1,232 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,335 |
1,169 |
$37K |
| D1110 |
Prophylaxis - adult |
820 |
789 |
$29K |
| D2394 |
|
237 |
132 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,759 |
1,642 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
814 |
790 |
$19K |
| D2331 |
|
183 |
118 |
$16K |
| D2330 |
|
205 |
114 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
336 |
318 |
$13K |
| D1120 |
Prophylaxis - child |
84 |
83 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
69 |
$2K |