| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,933 |
792 |
$192K |
| D1351 |
Sealant - per tooth |
2,709 |
488 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,378 |
2,329 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,616 |
2,913 |
$62K |
| D1120 |
Prophylaxis - child |
1,707 |
1,676 |
$60K |
| D0145 |
Oral evaluation for a patient under three years of age |
415 |
407 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,389 |
1,362 |
$45K |
| D1110 |
Prophylaxis - adult |
876 |
855 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,966 |
2,911 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,125 |
3,058 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
215 |
$34K |
| D2332 |
|
41 |
13 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
164 |
160 |
$5K |
| D0272 |
Bitewings - two radiographic images |
161 |
160 |
$4K |
| D0603 |
|
2,769 |
2,721 |
$0.00 |
| D0602 |
|
515 |
511 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |