| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,539 |
3,231 |
$785K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,238 |
2,585 |
$455K |
| D1351 |
Sealant - per tooth |
7,151 |
1,981 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,952 |
3,831 |
$131K |
| D1120 |
Prophylaxis - child |
3,325 |
3,217 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,615 |
4,446 |
$112K |
| D1110 |
Prophylaxis - adult |
1,722 |
1,673 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,702 |
2,620 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
845 |
614 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,044 |
4,890 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
4,664 |
4,505 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
318 |
310 |
$43K |
| D2330 |
|
468 |
325 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,129 |
1,092 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,147 |
1,109 |
$25K |
| D0350 |
|
1,094 |
1,044 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
196 |
$14K |
| D2331 |
|
133 |
94 |
$13K |
| D0330 |
Panoramic radiographic image |
331 |
320 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D1352 |
|
265 |
107 |
$449.28 |
| D7111 |
|
19 |
15 |
$206.46 |
| D0603 |
|
5,628 |
5,405 |
$0.00 |