| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,537 |
1,769 |
$598K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,124 |
1,034 |
$334K |
| D0120 |
Periodic oral evaluation - established patient |
4,422 |
4,349 |
$113K |
| D1110 |
Prophylaxis - adult |
2,919 |
2,858 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,189 |
4,098 |
$68K |
| D1120 |
Prophylaxis - child |
2,466 |
2,423 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,209 |
2,148 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,484 |
1,434 |
$65K |
| D0330 |
Panoramic radiographic image |
1,446 |
1,391 |
$65K |
| D0160 |
|
867 |
838 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,073 |
2,959 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
317 |
194 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,815 |
2,558 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
784 |
$31K |
| D4355 |
|
175 |
171 |
$12K |
| D0272 |
Bitewings - two radiographic images |
392 |
384 |
$7K |
| D4341 |
|
37 |
18 |
$4K |
| D1330 |
|
12 |
12 |
$0.00 |