| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
730 |
454 |
$76K |
| D0145 |
Oral evaluation for a patient under three years of age |
537 |
531 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,287 |
2,276 |
$65K |
| D1110 |
Prophylaxis - adult |
1,171 |
1,164 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
639 |
391 |
$50K |
| D1351 |
Sealant - per tooth |
1,680 |
510 |
$46K |
| D1120 |
Prophylaxis - child |
1,216 |
1,209 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,145 |
1,142 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,411 |
2,401 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,773 |
2,305 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,448 |
2,419 |
$30K |
| D0272 |
Bitewings - two radiographic images |
980 |
976 |
$23K |
| D0350 |
|
701 |
691 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
76 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
38 |
$1K |
| D0602 |
|
508 |
507 |
$0.00 |
| D0601 |
|
456 |
454 |
$0.00 |
| D0603 |
|
1,862 |
1,851 |
$0.00 |