| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,086 |
649 |
$311K |
| D0120 |
Periodic oral evaluation - established patient |
2,312 |
2,305 |
$66K |
| D1120 |
Prophylaxis - child |
1,371 |
1,365 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,308 |
2,257 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,299 |
2,289 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,287 |
2,279 |
$28K |
| D1110 |
Prophylaxis - adult |
439 |
439 |
$24K |
| D0274 |
Bitewings - four radiographic images |
696 |
693 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,101 |
1,099 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
101 |
101 |
$14K |
| D1351 |
Sealant - per tooth |
529 |
88 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
12 |
$4K |
| D0603 |
|
3,096 |
3,082 |
$0.00 |