| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,285 |
652 |
$123K |
| D1351 |
Sealant - per tooth |
2,556 |
544 |
$67K |
| D1120 |
Prophylaxis - child |
1,627 |
1,550 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,785 |
1,683 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,608 |
2,487 |
$36K |
| D1110 |
Prophylaxis - adult |
642 |
605 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,122 |
1,840 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
224 |
212 |
$30K |
| D0274 |
Bitewings - four radiographic images |
894 |
836 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,011 |
1,906 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
602 |
566 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
152 |
$10K |
| D0272 |
Bitewings - two radiographic images |
234 |
226 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D1330 |
|
17 |
13 |
$86.00 |
| D0602 |
|
246 |
235 |
$0.01 |
| D0603 |
|
485 |
458 |
$0.00 |
| D0601 |
|
1,695 |
1,629 |
$0.00 |