| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,906 |
1,577 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
4,742 |
4,666 |
$134K |
| D1110 |
Prophylaxis - adult |
2,408 |
2,373 |
$120K |
| D1120 |
Prophylaxis - child |
3,127 |
3,069 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,163 |
4,098 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
599 |
399 |
$80K |
| D0272 |
Bitewings - two radiographic images |
3,068 |
3,022 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,086 |
1,042 |
$53K |
| D1351 |
Sealant - per tooth |
759 |
190 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
148 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
733 |
706 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
190 |
$3K |
| D9986 |
|
59 |
58 |
$0.00 |