| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
779 |
429 |
$61K |
| D1120 |
Prophylaxis - child |
1,299 |
1,215 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,535 |
1,475 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
538 |
298 |
$35K |
| D1110 |
Prophylaxis - adult |
601 |
581 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,069 |
1,008 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,230 |
1,194 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
314 |
127 |
$15K |
| D0274 |
Bitewings - four radiographic images |
544 |
527 |
$14K |
| D2140 |
|
251 |
113 |
$10K |
| D1351 |
Sealant - per tooth |
355 |
123 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
235 |
$10K |
| D1206 |
Topical application of fluoride varnish |
308 |
279 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
294 |
283 |
$5K |
| D0330 |
Panoramic radiographic image |
75 |
75 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
171 |
111 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |