| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,096 |
2,031 |
$216K |
| D1120 |
Prophylaxis - child |
3,187 |
3,187 |
$143K |
| D1206 |
Topical application of fluoride varnish |
4,557 |
4,556 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,681 |
5,680 |
$142K |
| D1110 |
Prophylaxis - adult |
2,729 |
2,728 |
$123K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,478 |
1,139 |
$81K |
| D0274 |
Bitewings - four radiographic images |
4,167 |
4,165 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
516 |
440 |
$44K |
| D2331 |
|
392 |
291 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,979 |
4,966 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
482 |
350 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,772 |
4,769 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
251 |
250 |
$11K |
| D0603 |
|
912 |
912 |
$9K |
| D1351 |
Sealant - per tooth |
453 |
164 |
$9K |
| D0272 |
Bitewings - two radiographic images |
550 |
550 |
$6K |
| D0602 |
|
360 |
360 |
$4K |
| D7111 |
|
76 |
59 |
$3K |
| D2140 |
|
74 |
55 |
$3K |
| D2160 |
|
48 |
43 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
51 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
62 |
$2K |
| D0601 |
|
43 |
43 |
$430.00 |