| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,198 |
1,003 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
4,710 |
4,479 |
$115K |
| D1110 |
Prophylaxis - adult |
2,918 |
2,785 |
$105K |
| D1120 |
Prophylaxis - child |
2,684 |
2,561 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,814 |
3,645 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,938 |
1,819 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,912 |
2,179 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,943 |
2,695 |
$41K |
| D0330 |
Panoramic radiographic image |
810 |
755 |
$41K |
| D1351 |
Sealant - per tooth |
1,377 |
350 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
270 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
782 |
731 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
602 |
557 |
$21K |
| D0272 |
Bitewings - two radiographic images |
837 |
810 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
16 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$730.80 |