| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,846 |
1,719 |
$290K |
| D1110 |
Prophylaxis - adult |
6,086 |
5,507 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
8,366 |
7,598 |
$194K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,336 |
848 |
$101K |
| D0330 |
Panoramic radiographic image |
1,947 |
1,717 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,045 |
2,745 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,549 |
5,032 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
669 |
485 |
$84K |
| D1120 |
Prophylaxis - child |
3,325 |
3,015 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,405 |
1,239 |
$55K |
| D1351 |
Sealant - per tooth |
2,161 |
474 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
873 |
773 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,428 |
1,302 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,549 |
1,349 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,029 |
954 |
$16K |
| D2332 |
|
53 |
28 |
$5K |
| D2335 |
|
15 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
66 |
$1K |
| D4355 |
|
14 |
14 |
$971.16 |
| D1999 |
|
72 |
67 |
$0.00 |