| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,057 |
878 |
$103K |
| D1110 |
Prophylaxis - adult |
1,866 |
1,727 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,634 |
2,465 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
665 |
348 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,294 |
1,192 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,965 |
1,799 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,412 |
759 |
$26K |
| D1120 |
Prophylaxis - child |
1,076 |
1,013 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
814 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
512 |
469 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,350 |
1,241 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
350 |
171 |
$12K |
| D1351 |
Sealant - per tooth |
723 |
134 |
$10K |
| D1206 |
Topical application of fluoride varnish |
488 |
461 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
230 |
$7K |
| D2335 |
|
48 |
12 |
$5K |
| D1999 |
|
485 |
394 |
$91.00 |