| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
1,970 |
1,045 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
782 |
374 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
968 |
$42K |
| D1120 |
Prophylaxis - child |
943 |
939 |
$42K |
| D1110 |
Prophylaxis - adult |
616 |
613 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,293 |
1,285 |
$26K |
| D8660 |
|
171 |
171 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
92 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
677 |
673 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
376 |
376 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,390 |
1,379 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
109 |
$17K |
| D0274 |
Bitewings - four radiographic images |
527 |
523 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
961 |
953 |
$13K |
| D0272 |
Bitewings - two radiographic images |
458 |
454 |
$10K |
| D1206 |
Topical application of fluoride varnish |
395 |
392 |
$9K |
| D0330 |
Panoramic radiographic image |
131 |
131 |
$7K |
| D1351 |
Sealant - per tooth |
147 |
45 |
$6K |
| D0340 |
|
53 |
53 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
55 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$1K |