| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,797 |
832 |
$169K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,239 |
1,143 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
3,475 |
3,350 |
$92K |
| D1120 |
Prophylaxis - child |
2,697 |
2,596 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,282 |
3,211 |
$77K |
| D1110 |
Prophylaxis - adult |
1,457 |
1,412 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,865 |
1,790 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,899 |
3,770 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
639 |
274 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
751 |
713 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,400 |
3,262 |
$40K |
| D1351 |
Sealant - per tooth |
1,556 |
195 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
340 |
194 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
934 |
877 |
$29K |
| D0603 |
|
2,550 |
2,492 |
$0.00 |
| D0602 |
|
3,115 |
2,942 |
$0.00 |