| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,168 |
444 |
$99K |
| D0145 |
Oral evaluation for a patient under three years of age |
582 |
575 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,195 |
2,142 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,937 |
2,186 |
$51K |
| D1120 |
Prophylaxis - child |
1,627 |
1,581 |
$46K |
| D1110 |
Prophylaxis - adult |
797 |
784 |
$33K |
| D1351 |
Sealant - per tooth |
1,490 |
295 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,063 |
2,940 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,347 |
2,286 |
$26K |
| D0272 |
Bitewings - two radiographic images |
942 |
921 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
479 |
469 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
101 |
$10K |
| D0330 |
Panoramic radiographic image |
393 |
377 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
25 |
$5K |
| D1206 |
Topical application of fluoride varnish |
337 |
336 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$240.15 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$207.60 |
| D0603 |
|
3,898 |
3,829 |
$44.52 |