| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
915 |
480 |
$71K |
| D1120 |
Prophylaxis - child |
1,356 |
1,348 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,661 |
1,649 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,489 |
1,715 |
$31K |
| D1351 |
Sealant - per tooth |
1,185 |
242 |
$30K |
| D1110 |
Prophylaxis - adult |
694 |
684 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
212 |
210 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,120 |
2,104 |
$26K |
| D0274 |
Bitewings - four radiographic images |
857 |
848 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
367 |
204 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,881 |
1,857 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
296 |
290 |
$16K |
| D0272 |
Bitewings - two radiographic images |
636 |
633 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
372 |
365 |
$11K |
| D0330 |
Panoramic radiographic image |
90 |
88 |
$2K |
| D0603 |
|
1,088 |
1,078 |
$0.06 |
| D0601 |
|
924 |
915 |
$0.00 |
| D0602 |
|
330 |
329 |
$0.00 |