| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,404 |
503 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
794 |
378 |
$75K |
| D1120 |
Prophylaxis - child |
483 |
479 |
$17K |
| D1110 |
Prophylaxis - adult |
284 |
276 |
$15K |
| D1351 |
Sealant - per tooth |
592 |
184 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
466 |
457 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
810 |
797 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
951 |
684 |
$11K |
| D0274 |
Bitewings - four radiographic images |
323 |
317 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
314 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
707 |
690 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
40 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
68 |
$5K |
| D0272 |
Bitewings - two radiographic images |
164 |
164 |
$4K |
| D0603 |
|
885 |
867 |
$0.00 |