| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
679 |
324 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,982 |
1,933 |
$50K |
| D1110 |
Prophylaxis - adult |
1,069 |
1,042 |
$40K |
| D1120 |
Prophylaxis - child |
1,325 |
1,301 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,604 |
1,343 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,855 |
1,813 |
$31K |
| D0330 |
Panoramic radiographic image |
432 |
425 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,600 |
1,536 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
528 |
$23K |
| D0274 |
Bitewings - four radiographic images |
730 |
708 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
67 |
$16K |
| D1351 |
Sealant - per tooth |
436 |
102 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
73 |
$8K |
| D0272 |
Bitewings - two radiographic images |
373 |
369 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
136 |
$5K |
| D1206 |
Topical application of fluoride varnish |
113 |
113 |
$2K |