| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,088 |
5,204 |
$1.42M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,331 |
3,010 |
$468K |
| D1351 |
Sealant - per tooth |
14,541 |
3,493 |
$352K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,213 |
6,053 |
$199K |
| D1120 |
Prophylaxis - child |
5,413 |
5,283 |
$188K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,943 |
5,441 |
$147K |
| D1110 |
Prophylaxis - adult |
2,457 |
2,396 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,085 |
7,891 |
$112K |
| D0145 |
Oral evaluation for a patient under three years of age |
782 |
769 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,356 |
2,313 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,935 |
2,870 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
5,612 |
5,467 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
881 |
848 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,884 |
1,850 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
242 |
118 |
$21K |
| D0330 |
Panoramic radiographic image |
315 |
310 |
$4K |
| D2330 |
|
20 |
13 |
$1K |
| D1352 |
|
36 |
16 |
$20.00 |
| D0603 |
|
9,088 |
8,729 |
$0.00 |
| D0601 |
|
137 |
134 |
$0.00 |