| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
865 |
325 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
1,885 |
1,867 |
$53K |
| D1120 |
Prophylaxis - child |
1,294 |
1,284 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,217 |
1,208 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,944 |
1,927 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,300 |
1,819 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,889 |
1,870 |
$23K |
| D1351 |
Sealant - per tooth |
846 |
233 |
$22K |
| D1110 |
Prophylaxis - adult |
160 |
159 |
$8K |
| D0274 |
Bitewings - four radiographic images |
84 |
83 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
14 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D0602 |
|
824 |
818 |
$0.00 |
| D0601 |
|
814 |
786 |
$0.00 |
| D0603 |
|
113 |
113 |
$0.00 |