| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,292 |
1,175 |
$303K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,724 |
683 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
2,927 |
2,862 |
$80K |
| D1110 |
Prophylaxis - adult |
1,184 |
1,148 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,782 |
1,733 |
$52K |
| D1120 |
Prophylaxis - child |
1,324 |
1,299 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,654 |
2,599 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,363 |
2,450 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,725 |
2,644 |
$33K |
| D1351 |
Sealant - per tooth |
1,158 |
283 |
$28K |
| D2332 |
|
193 |
55 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
125 |
123 |
$16K |
| D0330 |
Panoramic radiographic image |
382 |
376 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
166 |
$11K |
| D0272 |
Bitewings - two radiographic images |
477 |
466 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
276 |
$10K |
| D9944 |
|
15 |
15 |
$2K |
| D0603 |
|
3,921 |
3,825 |
$0.00 |