| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,182 |
1,025 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,428 |
3,397 |
$77K |
| D1110 |
Prophylaxis - adult |
2,038 |
2,002 |
$72K |
| D1351 |
Sealant - per tooth |
3,423 |
916 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
985 |
611 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,006 |
3,930 |
$57K |
| D1120 |
Prophylaxis - child |
1,867 |
1,819 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,660 |
3,598 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,292 |
4,137 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
354 |
$12K |
| D1999 |
|
804 |
696 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
120 |
$2K |
| D2331 |
|
27 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
38 |
37 |
$1K |
| D1330 |
|
19 |
19 |
$0.00 |