| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,221 |
7,061 |
$1.57M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,003 |
7,105 |
$1.45M |
| D1120 |
Prophylaxis - child |
7,169 |
6,820 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
8,933 |
8,534 |
$244K |
| D1110 |
Prophylaxis - adult |
4,497 |
4,282 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,805 |
11,237 |
$163K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,115 |
1,063 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,532 |
7,983 |
$134K |
| D0274 |
Bitewings - four radiographic images |
3,854 |
3,666 |
$121K |
| D1351 |
Sealant - per tooth |
4,384 |
1,144 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
8,591 |
8,108 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,486 |
1,417 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,622 |
2,461 |
$80K |
| D0272 |
Bitewings - two radiographic images |
3,444 |
3,263 |
$75K |
| D0330 |
Panoramic radiographic image |
170 |
157 |
$5K |
| D0603 |
|
12,912 |
12,284 |
$0.00 |
| D0602 |
|
95 |
92 |
$0.00 |