| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
262 |
$59K |
| D1120 |
Prophylaxis - child |
1,291 |
1,279 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,784 |
1,771 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,297 |
1,286 |
$32K |
| D1110 |
Prophylaxis - adult |
476 |
464 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
145 |
$24K |
| D1351 |
Sealant - per tooth |
568 |
136 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
576 |
561 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
187 |
$10K |
| D0330 |
Panoramic radiographic image |
238 |
224 |
$10K |
| D1330 |
|
936 |
927 |
$6K |
| D0274 |
Bitewings - four radiographic images |
205 |
192 |
$5K |
| D0272 |
Bitewings - two radiographic images |
155 |
153 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
148 |
137 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
30 |
$196.80 |