| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,405 |
1,045 |
$171K |
| D1110 |
Prophylaxis - adult |
2,661 |
2,657 |
$150K |
| D1120 |
Prophylaxis - child |
2,977 |
2,967 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,645 |
4,634 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
903 |
654 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,145 |
3,140 |
$51K |
| D1351 |
Sealant - per tooth |
853 |
434 |
$48K |
| D9990 |
|
2,190 |
2,043 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,409 |
1,409 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
311 |
225 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,005 |
1,004 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,466 |
3,415 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,098 |
1,041 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,816 |
2,801 |
$22K |
| D1206 |
Topical application of fluoride varnish |
870 |
869 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
504 |
489 |
$18K |
| D0272 |
Bitewings - two radiographic images |
977 |
976 |
$17K |
| D0330 |
Panoramic radiographic image |
171 |
171 |
$12K |
| D0240 |
|
187 |
185 |
$4K |
| D1320 |
|
344 |
313 |
$3K |