| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
858 |
348 |
$80K |
| D1351 |
Sealant - per tooth |
1,968 |
410 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,712 |
1,683 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
326 |
325 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
577 |
269 |
$42K |
| D1120 |
Prophylaxis - child |
1,201 |
1,179 |
$42K |
| D1110 |
Prophylaxis - adult |
718 |
711 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,925 |
1,896 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,443 |
1,812 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,995 |
1,923 |
$23K |
| D0272 |
Bitewings - two radiographic images |
908 |
889 |
$20K |
| D0274 |
Bitewings - four radiographic images |
577 |
573 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
190 |
$6K |
| D0603 |
|
687 |
677 |
$45.05 |
| D0602 |
|
1,366 |
1,360 |
$37.07 |
| D0601 |
|
253 |
250 |
$0.00 |