| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,092 |
1,030 |
$136K |
| D1120 |
Prophylaxis - child |
2,858 |
2,844 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,551 |
3,532 |
$87K |
| D1110 |
Prophylaxis - adult |
1,433 |
1,417 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,878 |
1,870 |
$56K |
| D1351 |
Sealant - per tooth |
2,661 |
386 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,487 |
1,479 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
798 |
780 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,556 |
2,540 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
4,345 |
4,180 |
$21K |
| D9920 |
|
487 |
456 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,625 |
3,588 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
424 |
424 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
130 |
$6K |
| D0601 |
|
682 |
671 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
68 |
$5K |
| D0272 |
Bitewings - two radiographic images |
425 |
425 |
$4K |
| D9110 |
|
140 |
132 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$270.00 |