| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
3,113 |
3,090 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,448 |
2,429 |
$85K |
| D4346 |
|
634 |
627 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,081 |
665 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,942 |
3,912 |
$72K |
| D1120 |
Prophylaxis - child |
2,182 |
2,168 |
$70K |
| D1351 |
Sealant - per tooth |
2,441 |
499 |
$58K |
| D1110 |
Prophylaxis - adult |
1,235 |
1,227 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,685 |
1,673 |
$38K |
| D0330 |
Panoramic radiographic image |
1,028 |
1,016 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
487 |
334 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,216 |
2,189 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
442 |
439 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,234 |
1,211 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
85 |
$11K |