| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
826 |
348 |
$33K |
| D1120 |
Prophylaxis - child |
969 |
930 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
146 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
484 |
$18K |
| D1110 |
Prophylaxis - adult |
268 |
263 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
822 |
789 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
24 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
683 |
657 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
933 |
877 |
$30.00 |
| D1351 |
Sealant - per tooth |
268 |
71 |
$19.41 |
| D1206 |
Topical application of fluoride varnish |
1,326 |
1,271 |
$16.35 |
| D0272 |
Bitewings - two radiographic images |
206 |
200 |
$13.44 |
| D0274 |
Bitewings - four radiographic images |
99 |
99 |
$0.00 |
| D1330 |
|
1,292 |
1,237 |
$0.00 |