| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,832 |
1,088 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
3,452 |
3,422 |
$98K |
| D1110 |
Prophylaxis - adult |
1,771 |
1,761 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
645 |
643 |
$90K |
| D1120 |
Prophylaxis - child |
2,454 |
2,433 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
978 |
604 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,274 |
4,241 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,668 |
1,973 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
690 |
685 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,356 |
1,350 |
$47K |
| D1351 |
Sealant - per tooth |
1,481 |
474 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,208 |
1,195 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,210 |
2,186 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
788 |
783 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0603 |
|
3,218 |
3,187 |
$0.00 |
| D0602 |
|
1,667 |
1,655 |
$0.00 |