| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,293 |
2,738 |
$518K |
| D1351 |
Sealant - per tooth |
10,800 |
2,572 |
$234K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,605 |
1,501 |
$169K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,783 |
7,127 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,589 |
4,526 |
$136K |
| D1120 |
Prophylaxis - child |
4,491 |
4,430 |
$130K |
| D0274 |
Bitewings - four radiographic images |
3,927 |
3,851 |
$103K |
| D1110 |
Prophylaxis - adult |
2,373 |
2,329 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,067 |
6,958 |
$82K |
| D0145 |
Oral evaluation for a patient under three years of age |
628 |
617 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
7,438 |
7,295 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,539 |
2,487 |
$60K |
| D0272 |
Bitewings - two radiographic images |
1,365 |
1,353 |
$25K |
| D2332 |
|
170 |
90 |
$14K |
| D0330 |
Panoramic radiographic image |
49 |
48 |
$3K |
| D2330 |
|
34 |
14 |
$2K |
| D1352 |
|
15 |
15 |
$79.88 |
| D0603 |
|
4,596 |
4,480 |
$0.01 |
| D0601 |
|
2,224 |
2,184 |
$0.00 |
| D0602 |
|
1,070 |
1,046 |
$0.00 |
| D1999 |
|
226 |
218 |
$0.00 |