| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
438 |
$71K |
| D1110 |
Prophylaxis - adult |
1,347 |
1,277 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,247 |
2,161 |
$60K |
| D1351 |
Sealant - per tooth |
1,534 |
485 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,226 |
1,164 |
$38K |
| D1120 |
Prophylaxis - child |
985 |
953 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,322 |
2,225 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
348 |
242 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,321 |
2,204 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,223 |
2,103 |
$22K |
| D0272 |
Bitewings - two radiographic images |
910 |
883 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$918.32 |
| D0330 |
Panoramic radiographic image |
33 |
32 |
$765.65 |
| D0602 |
|
145 |
144 |
$0.00 |
| D0603 |
|
1,943 |
1,907 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| D9986 |
|
12 |
12 |
$0.00 |