| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,307 |
1,550 |
$420K |
| D1110 |
Prophylaxis - adult |
3,772 |
3,722 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
5,508 |
5,439 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,875 |
6,784 |
$158K |
| D1120 |
Prophylaxis - child |
2,760 |
2,718 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
977 |
547 |
$101K |
| D1351 |
Sealant - per tooth |
2,921 |
741 |
$96K |
| D0330 |
Panoramic radiographic image |
2,014 |
1,977 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,959 |
2,904 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,110 |
1,094 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
598 |
564 |
$28K |
| D1330 |
|
2,997 |
2,953 |
$18K |
| D2750 |
|
31 |
26 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
64 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,183 |
1,076 |
$13K |
| D0272 |
Bitewings - two radiographic images |
623 |
611 |
$9K |
| D4341 |
|
104 |
38 |
$9K |
| D3120 |
|
138 |
88 |
$5K |
| D2950 |
|
49 |
42 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$209.92 |