| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
723 |
211 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
371 |
362 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
238 |
$49K |
| D1351 |
Sealant - per tooth |
891 |
142 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
864 |
799 |
$10K |
| D1110 |
Prophylaxis - adult |
253 |
230 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
366 |
306 |
$9K |
| D1120 |
Prophylaxis - child |
316 |
285 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
967 |
569 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
309 |
288 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
660 |
599 |
$7K |
| D0274 |
Bitewings - four radiographic images |
182 |
171 |
$5K |
| D0272 |
Bitewings - two radiographic images |
61 |
59 |
$1K |
| D9440 |
|
38 |
36 |
$1K |
| D0603 |
|
1,018 |
956 |
$27.43 |
| D0601 |
|
345 |
335 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |