| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,240 |
1,187 |
$325K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,417 |
710 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
2,097 |
2,085 |
$60K |
| D1110 |
Prophylaxis - adult |
998 |
991 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,938 |
2,088 |
$44K |
| D1120 |
Prophylaxis - child |
1,161 |
1,156 |
$42K |
| D0145 |
Oral evaluation for a patient under three years of age |
237 |
237 |
$34K |
| D0274 |
Bitewings - four radiographic images |
975 |
969 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,147 |
2,136 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,168 |
2,146 |
$27K |
| D0272 |
Bitewings - two radiographic images |
627 |
625 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
97 |
40 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$787.72 |
| D0603 |
|
2,516 |
2,504 |
$0.02 |