| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,319 |
1,352 |
$230K |
| D1351 |
Sealant - per tooth |
8,107 |
1,753 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
4,931 |
4,832 |
$139K |
| D1120 |
Prophylaxis - child |
3,385 |
3,320 |
$120K |
| D0145 |
Oral evaluation for a patient under three years of age |
856 |
841 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,626 |
5,393 |
$105K |
| D1110 |
Prophylaxis - adult |
1,987 |
1,948 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,096 |
3,031 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,066 |
599 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,596 |
5,490 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
5,762 |
5,617 |
$57K |
| D0350 |
|
5,165 |
5,059 |
$53K |
| D0330 |
Panoramic radiographic image |
732 |
717 |
$17K |
| D0272 |
Bitewings - two radiographic images |
709 |
692 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
286 |
278 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
43 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D1330 |
|
162 |
157 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$244.14 |
| D0603 |
|
3,783 |
3,736 |
$0.00 |
| D0601 |
|
591 |
576 |
$0.00 |
| D0602 |
|
1,938 |
1,909 |
$0.00 |