| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
657 |
284 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
516 |
207 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,342 |
1,141 |
$29K |
| D1110 |
Prophylaxis - adult |
759 |
626 |
$27K |
| D1351 |
Sealant - per tooth |
1,289 |
259 |
$24K |
| D1120 |
Prophylaxis - child |
842 |
722 |
$22K |
| D0274 |
Bitewings - four radiographic images |
732 |
641 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,516 |
1,282 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,446 |
1,242 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,413 |
1,172 |
$12K |
| D0272 |
Bitewings - two radiographic images |
573 |
503 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
99 |
$3K |
| D0602 |
|
909 |
836 |
$0.00 |
| D0603 |
|
840 |
628 |
$0.00 |
| D0601 |
|
72 |
18 |
$0.00 |