| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,702 |
567 |
$120K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,038 |
573 |
$65K |
| D2394 |
|
890 |
636 |
$63K |
| D0330 |
Panoramic radiographic image |
1,561 |
1,514 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,114 |
2,061 |
$49K |
| D1110 |
Prophylaxis - adult |
1,258 |
1,232 |
$46K |
| D4341 |
|
595 |
264 |
$41K |
| D1120 |
Prophylaxis - child |
511 |
492 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,430 |
1,387 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
812 |
787 |
$12K |
| D0274 |
Bitewings - four radiographic images |
530 |
515 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
224 |
220 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
863 |
833 |
$5K |
| D2332 |
|
54 |
34 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
38 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
24 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
73 |
64 |
$1K |
| D2160 |
|
20 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
166 |
115 |
$631.14 |