| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,261 |
3,673 |
$492K |
| D2335 |
|
3,665 |
2,275 |
$406K |
| D1110 |
Prophylaxis - adult |
5,940 |
5,908 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
8,622 |
8,570 |
$175K |
| D0274 |
Bitewings - four radiographic images |
7,402 |
7,385 |
$148K |
| D2394 |
|
858 |
770 |
$89K |
| D1351 |
Sealant - per tooth |
1,352 |
597 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
7,798 |
7,784 |
$78K |
| D1120 |
Prophylaxis - child |
2,350 |
2,332 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
771 |
541 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,286 |
3,263 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,688 |
7,682 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
614 |
612 |
$20K |
| D1206 |
Topical application of fluoride varnish |
274 |
274 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
90 |
$6K |
| D9110 |
|
13 |
13 |
$240.00 |