| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
501 |
241 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,482 |
1,422 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,796 |
1,772 |
$39K |
| D1120 |
Prophylaxis - child |
1,024 |
992 |
$34K |
| D1110 |
Prophylaxis - adult |
620 |
580 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,606 |
1,564 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,929 |
1,830 |
$22K |
| D1351 |
Sealant - per tooth |
881 |
185 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
287 |
142 |
$21K |
| D0274 |
Bitewings - four radiographic images |
666 |
626 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
130 |
130 |
$18K |
| D0272 |
Bitewings - two radiographic images |
371 |
355 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
184 |
$6K |
| D0602 |
|
1,139 |
1,120 |
$0.00 |
| D0601 |
|
528 |
514 |
$0.00 |
| D0603 |
|
218 |
214 |
$0.00 |