| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,007 |
433 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
922 |
469 |
$63K |
| D1110 |
Prophylaxis - adult |
1,781 |
1,746 |
$59K |
| D0330 |
Panoramic radiographic image |
669 |
622 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
1,016 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,277 |
1,255 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
840 |
747 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,011 |
993 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,220 |
1,156 |
$11K |
| D9630 |
|
538 |
531 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
881 |
416 |
$7K |
| D1206 |
Topical application of fluoride varnish |
421 |
420 |
$6K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$0.00 |