| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,961 |
1,137 |
$237K |
| D1110 |
Prophylaxis - adult |
3,620 |
3,568 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
5,097 |
5,018 |
$145K |
| D8670 |
Periodic orthodontic treatment visit |
1,856 |
1,757 |
$139K |
| D2750 |
|
239 |
160 |
$118K |
| D1206 |
Topical application of fluoride varnish |
4,304 |
4,242 |
$104K |
| D1120 |
Prophylaxis - child |
2,017 |
1,983 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
705 |
487 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,695 |
2,661 |
$58K |
| D0330 |
Panoramic radiographic image |
1,095 |
1,082 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
284 |
182 |
$46K |
| D1351 |
Sealant - per tooth |
896 |
132 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
513 |
$28K |
| D2950 |
|
208 |
147 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
324 |
322 |
$15K |
| D1330 |
|
1,909 |
1,879 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
696 |
671 |
$8K |
| D0272 |
Bitewings - two radiographic images |
457 |
447 |
$6K |
| D8660 |
|
26 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
111 |
109 |
$3K |
| D3120 |
|
38 |
32 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101 |
99 |
$984.00 |
| D9310 |
|
16 |
15 |
$720.00 |