| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,718 |
884 |
$272K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,198 |
1,186 |
$168K |
| D1120 |
Prophylaxis - child |
3,313 |
3,260 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,042 |
3,927 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,325 |
4,806 |
$105K |
| D1110 |
Prophylaxis - adult |
1,871 |
1,835 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,222 |
5,136 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
925 |
284 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,292 |
3,246 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
678 |
291 |
$64K |
| D1351 |
Sealant - per tooth |
2,397 |
418 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,128 |
4,966 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,879 |
1,853 |
$41K |
| D0274 |
Bitewings - four radiographic images |
979 |
962 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,384 |
1,187 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
118 |
118 |
$4K |
| D0330 |
Panoramic radiographic image |
117 |
113 |
$3K |
| D0601 |
|
6,925 |
6,297 |
$0.00 |