| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,283 |
594 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,536 |
2,461 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,555 |
3,308 |
$54K |
| D1120 |
Prophylaxis - child |
2,058 |
1,918 |
$41K |
| D1110 |
Prophylaxis - adult |
1,173 |
1,092 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,630 |
2,390 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
620 |
522 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,279 |
1,191 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
143 |
$14K |
| D1351 |
Sealant - per tooth |
842 |
218 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,306 |
1,936 |
$9K |
| D1999 |
|
883 |
764 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
90 |
$2K |