| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
799 |
471 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
944 |
474 |
$123K |
| D1110 |
Prophylaxis - adult |
1,152 |
1,127 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
702 |
687 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,074 |
1,060 |
$30K |
| D2335 |
|
181 |
85 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
585 |
572 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
133 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
821 |
811 |
$19K |
| D3120 |
|
491 |
289 |
$17K |
| D0272 |
Bitewings - two radiographic images |
668 |
649 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
651 |
631 |
$7K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$4K |
| D2332 |
|
22 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
64 |
64 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
266 |
256 |
$3K |
| D0274 |
Bitewings - four radiographic images |
63 |
59 |
$1K |