| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,375 |
664 |
$116K |
| D0145 |
Oral evaluation for a patient under three years of age |
700 |
689 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,321 |
3,193 |
$88K |
| D1120 |
Prophylaxis - child |
2,553 |
2,455 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,506 |
2,934 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,871 |
3,716 |
$51K |
| D1110 |
Prophylaxis - adult |
860 |
820 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,137 |
3,013 |
$35K |
| D1351 |
Sealant - per tooth |
1,385 |
380 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,034 |
982 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
395 |
372 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
115 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
213 |
$7K |
| D0272 |
Bitewings - two radiographic images |
165 |
160 |
$3K |
| D0602 |
|
2,475 |
2,416 |
$0.22 |
| D0603 |
|
2,389 |
2,303 |
$0.12 |