| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,899 |
1,858 |
$237K |
| D1110 |
Prophylaxis - adult |
1,824 |
1,823 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,008 |
773 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
2,795 |
2,793 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,045 |
2,044 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
878 |
678 |
$47K |
| D1120 |
Prophylaxis - child |
677 |
677 |
$29K |
| D1351 |
Sealant - per tooth |
280 |
129 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,201 |
1,193 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,063 |
1,063 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
24 |
24 |
$12K |
| D2954 |
|
66 |
62 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
196 |
196 |
$3K |
| D7111 |
|
48 |
40 |
$2K |
| D1206 |
Topical application of fluoride varnish |
51 |
51 |
$1K |
| D0272 |
Bitewings - two radiographic images |
60 |
60 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
38 |
$219.00 |
| D0603 |
|
94 |
94 |
$94.00 |
| D0602 |
|
18 |
18 |
$18.00 |
| D0601 |
|
14 |
14 |
$14.00 |