| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,746 |
1,094 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,208 |
604 |
$90K |
| D1110 |
Prophylaxis - adult |
1,477 |
1,462 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,438 |
2,410 |
$68K |
| D0145 |
Oral evaluation for a patient under three years of age |
475 |
469 |
$66K |
| D1120 |
Prophylaxis - child |
1,528 |
1,507 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,577 |
1,558 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,959 |
2,922 |
$42K |
| D1351 |
Sealant - per tooth |
1,298 |
299 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,854 |
2,814 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,704 |
2,626 |
$30K |
| D0350 |
|
1,246 |
1,235 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
578 |
569 |
$19K |
| D0272 |
Bitewings - two radiographic images |
683 |
678 |
$14K |
| D0330 |
Panoramic radiographic image |
375 |
368 |
$10K |
| D2330 |
|
69 |
39 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
12 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0602 |
|
1,763 |
1,738 |
$0.00 |
| D0603 |
|
2,024 |
2,004 |
$0.00 |