| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,037 |
1,542 |
$485K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,843 |
1,454 |
$282K |
| D1351 |
Sealant - per tooth |
5,809 |
995 |
$156K |
| D0145 |
Oral evaluation for a patient under three years of age |
673 |
665 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,487 |
2,458 |
$67K |
| D1110 |
Prophylaxis - adult |
1,108 |
1,094 |
$57K |
| D1120 |
Prophylaxis - child |
1,530 |
1,503 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,223 |
3,169 |
$45K |
| D2331 |
|
499 |
242 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,285 |
1,264 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,552 |
1,530 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
433 |
$15K |
| D0330 |
Panoramic radiographic image |
373 |
360 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
68 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
12 |
$3K |
| D2330 |
|
38 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$159.60 |
| D0603 |
|
403 |
401 |
$0.01 |
| D0601 |
|
1,781 |
1,763 |
$0.00 |
| D0602 |
|
1,142 |
1,119 |
$0.00 |