| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,538 |
490 |
$54K |
| D0330 |
Panoramic radiographic image |
921 |
778 |
$51K |
| D1110 |
Prophylaxis - adult |
937 |
823 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
78 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
833 |
727 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
141 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
783 |
304 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,100 |
947 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,155 |
1,019 |
$2K |
| D1351 |
Sealant - per tooth |
356 |
100 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,448 |
1,234 |
$1K |
| D1120 |
Prophylaxis - child |
255 |
216 |
$1K |
| D1330 |
|
1,858 |
1,619 |
$303.00 |
| D0272 |
Bitewings - two radiographic images |
140 |
125 |
$13.38 |
| D0602 |
|
77 |
76 |
$0.00 |