| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,064 |
1,165 |
$130K |
| D1120 |
Prophylaxis - child |
2,332 |
2,296 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,312 |
2,259 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,015 |
2,963 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
952 |
538 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
413 |
292 |
$31K |
| D1110 |
Prophylaxis - adult |
457 |
451 |
$24K |
| D1351 |
Sealant - per tooth |
975 |
300 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
772 |
770 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,045 |
1,037 |
$19K |
| D0272 |
Bitewings - two radiographic images |
890 |
874 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,179 |
1,166 |
$14K |
| D1354 |
|
940 |
214 |
$11K |
| D0274 |
Bitewings - four radiographic images |
265 |
259 |
$8K |
| D0330 |
Panoramic radiographic image |
112 |
104 |
$4K |
| D2394 |
|
29 |
15 |
$3K |
| D2331 |
|
19 |
12 |
$1K |
| D2332 |
|
16 |
14 |
$1K |
| D9986 |
|
37 |
33 |
$9.00 |
| D0603 |
|
154 |
152 |
$0.00 |