| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,513 |
680 |
$98K |
| D1110 |
Prophylaxis - adult |
1,897 |
1,873 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,866 |
1,843 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,985 |
1,968 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,115 |
1,099 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,687 |
1,676 |
$30K |
| D0330 |
Panoramic radiographic image |
510 |
495 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
255 |
$26K |
| D1120 |
Prophylaxis - child |
1,136 |
1,131 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
571 |
539 |
$16K |
| D1351 |
Sealant - per tooth |
554 |
162 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
31 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
439 |
$3K |
| D2140 |
|
58 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
204 |
201 |
$2K |
| D2331 |
|
23 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
47 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$923.40 |
| D1330 |
|
18 |
18 |
$0.00 |