| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
620 |
523 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
685 |
484 |
$75K |
| D1120 |
Prophylaxis - child |
1,498 |
1,474 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,047 |
2,015 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,753 |
1,725 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,069 |
1,056 |
$44K |
| D0330 |
Panoramic radiographic image |
538 |
535 |
$38K |
| D1110 |
Prophylaxis - adult |
628 |
618 |
$36K |
| D1351 |
Sealant - per tooth |
840 |
288 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
233 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
619 |
$13K |
| D0272 |
Bitewings - two radiographic images |
287 |
281 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
310 |
277 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
58 |
$1K |