| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
727 |
320 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
510 |
500 |
$65K |
| D1351 |
Sealant - per tooth |
1,771 |
284 |
$46K |
| D1120 |
Prophylaxis - child |
832 |
811 |
$28K |
| D1110 |
Prophylaxis - adult |
540 |
529 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
346 |
206 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
857 |
840 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
633 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,106 |
1,258 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,353 |
1,321 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,351 |
1,312 |
$14K |
| D0274 |
Bitewings - four radiographic images |
413 |
406 |
$12K |
| D0272 |
Bitewings - two radiographic images |
542 |
528 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
239 |
$10K |
| D0330 |
Panoramic radiographic image |
473 |
463 |
$8K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$191.10 |
| D0603 |
|
1,393 |
1,365 |
$18.00 |
| D0601 |
|
422 |
402 |
$0.00 |
| D0602 |
|
33 |
32 |
$0.00 |