| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,872 |
1,100 |
$216K |
| D1120 |
Prophylaxis - child |
3,464 |
3,456 |
$133K |
| D1206 |
Topical application of fluoride varnish |
4,147 |
4,131 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,002 |
655 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,374 |
3,361 |
$87K |
| D1110 |
Prophylaxis - adult |
1,024 |
1,006 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
748 |
744 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
375 |
370 |
$27K |
| D0272 |
Bitewings - two radiographic images |
571 |
568 |
$12K |
| D0274 |
Bitewings - four radiographic images |
347 |
345 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
57 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
533 |
516 |
$9K |
| D1351 |
Sealant - per tooth |
232 |
54 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
144 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
207 |
110 |
$2K |