| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,583 |
1,114 |
$257K |
| D0120 |
Periodic oral evaluation - established patient |
7,039 |
6,777 |
$195K |
| D1110 |
Prophylaxis - adult |
3,528 |
3,414 |
$185K |
| D1120 |
Prophylaxis - child |
3,864 |
3,724 |
$136K |
| D0145 |
Oral evaluation for a patient under three years of age |
967 |
932 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,693 |
691 |
$128K |
| D0274 |
Bitewings - four radiographic images |
4,148 |
4,008 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,359 |
7,106 |
$104K |
| D1351 |
Sealant - per tooth |
3,443 |
1,103 |
$92K |
| D0272 |
Bitewings - two radiographic images |
2,199 |
2,116 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,099 |
979 |
$44K |
| D0330 |
Panoramic radiographic image |
936 |
919 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
263 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,541 |
1,476 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
175 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D9986 |
|
71 |
63 |
$0.00 |
| D0603 |
|
8,333 |
8,030 |
$0.00 |