| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,014 |
419 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,068 |
1,031 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,230 |
1,342 |
$32K |
| D1120 |
Prophylaxis - child |
831 |
807 |
$29K |
| D1110 |
Prophylaxis - adult |
478 |
462 |
$23K |
| D1351 |
Sealant - per tooth |
818 |
209 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,406 |
1,353 |
$19K |
| D0274 |
Bitewings - four radiographic images |
694 |
662 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,482 |
1,398 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
83 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
308 |
297 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
101 |
$7K |
| D0272 |
Bitewings - two radiographic images |
110 |
106 |
$2K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$2K |
| D0603 |
|
1,666 |
1,630 |
$0.00 |