| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,727 |
972 |
$117K |
| D1120 |
Prophylaxis - child |
1,747 |
1,649 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,841 |
1,685 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
523 |
388 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,566 |
1,495 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
612 |
437 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,645 |
1,589 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,786 |
2,460 |
$15K |
| D1110 |
Prophylaxis - adult |
324 |
322 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
527 |
513 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
356 |
330 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,368 |
1,299 |
$5K |
| D1351 |
Sealant - per tooth |
72 |
54 |
$4K |
| D1999 |
|
14 |
13 |
$0.00 |