| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
818 |
220 |
$82K |
| D1351 |
Sealant - per tooth |
1,739 |
284 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
93 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,302 |
917 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
525 |
491 |
$16K |
| D1110 |
Prophylaxis - adult |
273 |
264 |
$13K |
| D1120 |
Prophylaxis - child |
386 |
372 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
747 |
724 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,078 |
1,018 |
$10K |
| D0272 |
Bitewings - two radiographic images |
390 |
378 |
$8K |
| D0274 |
Bitewings - four radiographic images |
282 |
267 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
257 |
244 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
62 |
$4K |
| D0330 |
Panoramic radiographic image |
122 |
114 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
16 |
$345.64 |
| D0603 |
|
1,064 |
1,030 |
$0.00 |