| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,855 |
1,766 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
414 |
222 |
$44K |
| D1110 |
Prophylaxis - adult |
1,083 |
1,019 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,269 |
1,069 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,516 |
1,441 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
194 |
112 |
$24K |
| D1120 |
Prophylaxis - child |
884 |
841 |
$24K |
| D0274 |
Bitewings - four radiographic images |
692 |
640 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,319 |
1,217 |
$19K |
| D0330 |
Panoramic radiographic image |
206 |
195 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
211 |
180 |
$8K |
| D1351 |
Sealant - per tooth |
103 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
148 |
146 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
63 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
13 |
$1K |