| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,026 |
3,380 |
$429K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,866 |
3,062 |
$288K |
| D1110 |
Prophylaxis - adult |
5,952 |
5,792 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
6,980 |
6,793 |
$166K |
| D1206 |
Topical application of fluoride varnish |
7,816 |
7,591 |
$162K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,587 |
1,112 |
$132K |
| D1120 |
Prophylaxis - child |
3,123 |
3,042 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,751 |
3,647 |
$97K |
| D0330 |
Panoramic radiographic image |
2,245 |
2,184 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,852 |
1,803 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,833 |
1,789 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,406 |
2,311 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,629 |
1,334 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
465 |
459 |
$10K |
| D1354 |
|
757 |
195 |
$7K |
| D1351 |
Sealant - per tooth |
112 |
44 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
138 |
$3K |
| D2950 |
|
15 |
12 |
$1K |
| D2331 |
|
19 |
13 |
$1K |
| D1330 |
|
906 |
904 |
$0.00 |
| D9215 |
|
44 |
43 |
$0.00 |
| D0431 |
|
488 |
485 |
$0.00 |
| D1999 |
|
78 |
76 |
$0.00 |