| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,080 |
465 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,649 |
3,605 |
$103K |
| D1120 |
Prophylaxis - child |
2,620 |
2,578 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,123 |
5,051 |
$73K |
| D1110 |
Prophylaxis - adult |
1,333 |
1,317 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,597 |
4,602 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,892 |
4,808 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,741 |
1,722 |
$58K |
| D1351 |
Sealant - per tooth |
2,089 |
388 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
869 |
858 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
137 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
137 |
$19K |
| D0272 |
Bitewings - two radiographic images |
768 |
765 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D0602 |
|
1,394 |
1,376 |
$0.00 |
| D0603 |
|
2,477 |
2,450 |
$0.00 |
| D0601 |
|
578 |
570 |
$0.00 |