| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
2,552 |
456 |
$253K |
| D1110 |
Prophylaxis - adult |
1,507 |
1,406 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
450 |
105 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,238 |
1,154 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
400 |
379 |
$17K |
| D0274 |
Bitewings - four radiographic images |
352 |
334 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
324 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
59 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
252 |
$6K |
| D1120 |
Prophylaxis - child |
154 |
140 |
$6K |
| D2160 |
|
74 |
31 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
37 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
24 |
$2K |
| D2140 |
|
36 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
121 |
108 |
$1K |
| D1206 |
Topical application of fluoride varnish |
26 |
25 |
$603.78 |