| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,524 |
350 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
116 |
$24K |
| D1110 |
Prophylaxis - adult |
622 |
603 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
92 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
492 |
482 |
$16K |
| D0274 |
Bitewings - four radiographic images |
402 |
388 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
362 |
351 |
$6K |
| D0330 |
Panoramic radiographic image |
62 |
62 |
$4K |
| D2950 |
|
19 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
77 |
77 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
293 |
280 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
163 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
72 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
28 |
$0.00 |
| D4341 |
|
44 |
12 |
$0.00 |