| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,477 |
402 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
617 |
223 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
312 |
300 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,318 |
1,295 |
$35K |
| D1120 |
Prophylaxis - child |
1,024 |
1,008 |
$35K |
| D1110 |
Prophylaxis - adult |
468 |
457 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,521 |
1,492 |
$21K |
| D0272 |
Bitewings - two radiographic images |
953 |
937 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,601 |
1,540 |
$15K |
| D0274 |
Bitewings - four radiographic images |
490 |
481 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,499 |
1,473 |
$14K |
| D0330 |
Panoramic radiographic image |
170 |
164 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
99 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$988.96 |
| D0603 |
|
1,847 |
1,812 |
$0.00 |