| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,206 |
1,280 |
$95K |
| D1110 |
Prophylaxis - adult |
3,139 |
2,960 |
$85K |
| D1120 |
Prophylaxis - child |
1,522 |
1,436 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
3,645 |
3,447 |
$49K |
| D0330 |
Panoramic radiographic image |
1,601 |
1,488 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,313 |
2,159 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,039 |
667 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,394 |
1,305 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,314 |
1,224 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,196 |
2,074 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
236 |
167 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,285 |
2,079 |
$11K |
| D0272 |
Bitewings - two radiographic images |
313 |
307 |
$5K |
| D1351 |
Sealant - per tooth |
167 |
41 |
$3K |
| D2331 |
|
51 |
29 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
887 |
477 |
$1K |
| D2330 |
|
23 |
13 |
$1K |
| D2332 |
|
14 |
12 |
$916.50 |
| D1999 |
|
1,315 |
1,078 |
$0.00 |
| D0602 |
|
178 |
166 |
$0.00 |
| D0601 |
|
180 |
172 |
$0.00 |