| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,632 |
733 |
$159K |
| D1110 |
Prophylaxis - adult |
1,500 |
1,475 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,686 |
2,636 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,916 |
1,880 |
$64K |
| D1351 |
Sealant - per tooth |
2,300 |
468 |
$60K |
| D1120 |
Prophylaxis - child |
1,394 |
1,369 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,054 |
3,206 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,922 |
2,872 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,367 |
3,295 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
317 |
171 |
$24K |
| D0272 |
Bitewings - two radiographic images |
620 |
609 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
390 |
378 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
79 |
74 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
54 |
$8K |
| D0602 |
|
846 |
833 |
$0.00 |
| D0603 |
|
2,616 |
2,585 |
$0.00 |