| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,174 |
849 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
907 |
537 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,036 |
1,779 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,186 |
1,121 |
$36K |
| D1110 |
Prophylaxis - adult |
662 |
622 |
$32K |
| D1120 |
Prophylaxis - child |
945 |
894 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
939 |
864 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,753 |
1,658 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
823 |
793 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,965 |
1,817 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
70 |
66 |
$9K |
| D0330 |
Panoramic radiographic image |
188 |
172 |
$6K |
| D0272 |
Bitewings - two radiographic images |
282 |
265 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
332 |
271 |
$6K |
| D1351 |
Sealant - per tooth |
43 |
13 |
$1K |
| D0603 |
|
2,207 |
2,082 |
$0.00 |