| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,649 |
1,267 |
$253K |
| D1351 |
Sealant - per tooth |
4,608 |
1,091 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,559 |
3,398 |
$95K |
| D1120 |
Prophylaxis - child |
2,484 |
2,374 |
$85K |
| D1110 |
Prophylaxis - adult |
1,658 |
1,588 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
527 |
500 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
803 |
413 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,239 |
4,043 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,639 |
4,399 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,655 |
1,593 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,150 |
2,073 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,169 |
3,996 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
590 |
568 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
99 |
$2K |
| D0603 |
|
4,737 |
4,531 |
$54.41 |
| D0602 |
|
321 |
311 |
$0.01 |