| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
849 |
355 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
407 |
406 |
$57K |
| D1351 |
Sealant - per tooth |
2,097 |
415 |
$55K |
| D1120 |
Prophylaxis - child |
1,249 |
1,232 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,547 |
1,538 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,025 |
1,994 |
$29K |
| D1110 |
Prophylaxis - adult |
501 |
489 |
$26K |
| D0274 |
Bitewings - four radiographic images |
781 |
762 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
95 |
$15K |
| D0272 |
Bitewings - two radiographic images |
610 |
602 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
301 |
290 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
816 |
348 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
579 |
555 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$244.14 |
| D0603 |
|
2,915 |
2,889 |
$18.05 |