| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,529 |
782 |
$246K |
| D1351 |
Sealant - per tooth |
3,005 |
718 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
801 |
324 |
$58K |
| D1120 |
Prophylaxis - child |
1,626 |
1,578 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
403 |
397 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,634 |
1,588 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
556 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,339 |
1,055 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,197 |
2,135 |
$31K |
| D0240 |
|
2,570 |
1,128 |
$21K |
| D1110 |
Prophylaxis - adult |
379 |
373 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
445 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,138 |
1,107 |
$14K |
| D1330 |
|
147 |
134 |
$1K |
| D0272 |
Bitewings - two radiographic images |
45 |
45 |
$1K |
| D0602 |
|
217 |
212 |
$0.00 |
| D0603 |
|
2,386 |
2,304 |
$0.00 |