| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,338 |
1,248 |
$267K |
| D1120 |
Prophylaxis - child |
3,997 |
3,995 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
4,623 |
4,619 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,038 |
600 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,106 |
3,106 |
$77K |
| D1110 |
Prophylaxis - adult |
1,544 |
1,541 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
3,208 |
3,091 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,549 |
1,547 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,455 |
1,455 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,350 |
2,530 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
509 |
508 |
$22K |
| D0272 |
Bitewings - two radiographic images |
873 |
872 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
109 |
66 |
$15K |
| D1351 |
Sealant - per tooth |
308 |
54 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
181 |
179 |
$8K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$4K |
| D0240 |
|
52 |
26 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$344.00 |