| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,315 |
476 |
$112K |
| D1351 |
Sealant - per tooth |
2,797 |
527 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,339 |
2,273 |
$60K |
| D1110 |
Prophylaxis - adult |
1,223 |
1,180 |
$56K |
| D1120 |
Prophylaxis - child |
1,389 |
1,363 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,437 |
1,391 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,014 |
2,410 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,587 |
2,492 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,571 |
1,538 |
$21K |
| D0272 |
Bitewings - two radiographic images |
913 |
895 |
$19K |
| D0350 |
|
1,396 |
1,360 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
97 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
88 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
164 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
287 |
$8K |
| D1206 |
Topical application of fluoride varnish |
504 |
491 |
$7K |
| D0330 |
Panoramic radiographic image |
263 |
255 |
$3K |
| D1330 |
|
751 |
725 |
$341.81 |
| D0603 |
|
3,208 |
3,130 |
$81.33 |