| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,356 |
1,736 |
$330K |
| D1351 |
Sealant - per tooth |
6,426 |
1,537 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,815 |
1,043 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,393 |
3,270 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,692 |
3,482 |
$93K |
| D1120 |
Prophylaxis - child |
2,362 |
2,296 |
$83K |
| D0274 |
Bitewings - four radiographic images |
1,935 |
1,859 |
$64K |
| D1110 |
Prophylaxis - adult |
1,185 |
1,127 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,588 |
3,455 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,615 |
3,486 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
266 |
262 |
$37K |
| D0272 |
Bitewings - two radiographic images |
832 |
809 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
196 |
196 |
$6K |
| D0602 |
|
982 |
928 |
$0.00 |
| D0603 |
|
2,629 |
2,530 |
$0.00 |
| D0601 |
|
130 |
129 |
$0.00 |