| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,333 |
2,448 |
$673K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,556 |
2,364 |
$540K |
| D0120 |
Periodic oral evaluation - established patient |
9,827 |
9,683 |
$291K |
| D1110 |
Prophylaxis - adult |
4,670 |
4,589 |
$283K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,992 |
10,817 |
$252K |
| D1120 |
Prophylaxis - child |
5,588 |
5,506 |
$241K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
838 |
527 |
$134K |
| D8670 |
Periodic orthodontic treatment visit |
1,512 |
1,476 |
$113K |
| D0330 |
Panoramic radiographic image |
1,434 |
1,397 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,006 |
1,969 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,575 |
2,535 |
$40K |
| D1330 |
|
5,169 |
5,071 |
$32K |
| D1351 |
Sealant - per tooth |
887 |
159 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
495 |
485 |
$26K |
| D1206 |
Topical application of fluoride varnish |
347 |
342 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$518.40 |