| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,049 |
583 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,458 |
3,348 |
$96K |
| D1110 |
Prophylaxis - adult |
1,801 |
1,729 |
$94K |
| D1120 |
Prophylaxis - child |
1,809 |
1,750 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,819 |
1,755 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,563 |
3,443 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
679 |
386 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,654 |
3,510 |
$43K |
| D1351 |
Sealant - per tooth |
1,480 |
330 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,543 |
3,389 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,552 |
1,504 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
234 |
211 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$459.16 |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$453.23 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$206.58 |
| D1330 |
|
18 |
17 |
$122.50 |
| D0602 |
|
3,374 |
3,238 |
$0.02 |
| D0601 |
|
496 |
466 |
$0.00 |
| D0603 |
|
29 |
28 |
$0.00 |
| D1999 |
|
489 |
486 |
$0.00 |