| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
721 |
316 |
$67K |
| D1120 |
Prophylaxis - child |
1,324 |
1,305 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,594 |
1,561 |
$44K |
| D1110 |
Prophylaxis - adult |
722 |
708 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,303 |
2,268 |
$33K |
| D0274 |
Bitewings - four radiographic images |
863 |
853 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,977 |
1,942 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,930 |
1,856 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
123 |
123 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
478 |
473 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
207 |
$14K |
| D0272 |
Bitewings - two radiographic images |
548 |
544 |
$12K |
| D1351 |
Sealant - per tooth |
239 |
35 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
17 |
$2K |
| D0603 |
|
1,493 |
1,464 |
$0.00 |
| D0601 |
|
409 |
406 |
$0.00 |
| D0602 |
|
266 |
264 |
$0.00 |