| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,871 |
4,934 |
$1.13M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,813 |
4,319 |
$644K |
| D1351 |
Sealant - per tooth |
21,258 |
4,612 |
$515K |
| D1120 |
Prophylaxis - child |
6,446 |
6,350 |
$226K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,443 |
9,515 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,956 |
5,854 |
$201K |
| D1110 |
Prophylaxis - adult |
3,788 |
3,729 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,510 |
10,339 |
$148K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,033 |
1,018 |
$141K |
| D0274 |
Bitewings - four radiographic images |
3,714 |
3,657 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
4,392 |
4,323 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
9,794 |
9,614 |
$118K |
| D0272 |
Bitewings - two radiographic images |
5,074 |
5,005 |
$115K |
| D2332 |
|
25 |
13 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0603 |
|
8,758 |
8,658 |
$0.00 |
| D0601 |
|
1,802 |
1,778 |
$0.00 |
| D0602 |
|
550 |
548 |
$0.00 |