| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
500 |
235 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,256 |
2,034 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,485 |
2,248 |
$53K |
| D1120 |
Prophylaxis - child |
1,573 |
1,420 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,056 |
984 |
$44K |
| D0274 |
Bitewings - four radiographic images |
658 |
627 |
$24K |
| D1110 |
Prophylaxis - adult |
437 |
373 |
$18K |
| D0330 |
Panoramic radiographic image |
211 |
202 |
$14K |
| D1351 |
Sealant - per tooth |
289 |
49 |
$7K |
| D0272 |
Bitewings - two radiographic images |
201 |
180 |
$5K |
| 99157 |
|
25 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
86 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
15 |
$2K |