| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33,356 |
9,839 |
$3.22M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,107 |
6,453 |
$1.27M |
| D1351 |
Sealant - per tooth |
22,202 |
4,900 |
$558K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,352 |
12,031 |
$404K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,123 |
10,160 |
$334K |
| D1120 |
Prophylaxis - child |
9,113 |
8,876 |
$315K |
| D1110 |
Prophylaxis - adult |
4,497 |
4,359 |
$233K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,650 |
1,614 |
$224K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,633 |
13,258 |
$190K |
| D0210 |
Intraoral - complete series of radiographic images |
2,757 |
2,656 |
$180K |
| D0220 |
Intraoral - periapical first radiographic image |
10,491 |
10,230 |
$121K |
| D0274 |
Bitewings - four radiographic images |
2,780 |
2,694 |
$80K |
| D0272 |
Bitewings - two radiographic images |
2,430 |
2,376 |
$54K |
| D2331 |
|
458 |
217 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,486 |
1,409 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
393 |
252 |
$35K |
| D0330 |
Panoramic radiographic image |
701 |
682 |
$8K |
| D0603 |
|
14,390 |
13,768 |
$0.00 |
| D0601 |
|
1,074 |
1,054 |
$0.00 |
| D0602 |
|
106 |
103 |
$0.00 |