| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,468 |
3,380 |
$846K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,437 |
2,358 |
$419K |
| D1110 |
Prophylaxis - adult |
4,437 |
4,355 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
8,305 |
8,168 |
$233K |
| D0274 |
Bitewings - four radiographic images |
4,684 |
4,618 |
$157K |
| D2330 |
|
2,022 |
466 |
$149K |
| D1120 |
Prophylaxis - child |
3,730 |
3,674 |
$134K |
| D0145 |
Oral evaluation for a patient under three years of age |
857 |
844 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,278 |
8,167 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
8,166 |
7,998 |
$99K |
| D1351 |
Sealant - per tooth |
3,408 |
1,149 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,015 |
7,670 |
$88K |
| D0350 |
|
4,583 |
4,103 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,020 |
1,978 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
304 |
219 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
207 |
$14K |
| D2332 |
|
85 |
53 |
$11K |
| D1330 |
|
404 |
397 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$987.44 |
| D0330 |
Panoramic radiographic image |
67 |
65 |
$674.03 |
| D0603 |
|
9,288 |
9,167 |
$0.00 |
| D0602 |
|
276 |
275 |
$0.00 |
| D0601 |
|
70 |
70 |
$0.00 |