| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,225 |
1,144 |
$402K |
| D2330 |
|
2,352 |
843 |
$137K |
| D2331 |
|
1,403 |
568 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,437 |
508 |
$110K |
| D2332 |
|
583 |
288 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,754 |
1,166 |
$28K |
| D1120 |
Prophylaxis - child |
757 |
709 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,234 |
1,168 |
$14K |
| D1351 |
Sealant - per tooth |
524 |
88 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
394 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
578 |
547 |
$12K |
| D0274 |
Bitewings - four radiographic images |
323 |
315 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
991 |
939 |
$10K |
| D1110 |
Prophylaxis - adult |
232 |
228 |
$10K |
| D0272 |
Bitewings - two radiographic images |
406 |
394 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
35 |
$4K |
| D0603 |
|
1,085 |
1,013 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |