| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,043 |
475 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
581 |
572 |
$77K |
| D1120 |
Prophylaxis - child |
1,176 |
1,104 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,864 |
1,168 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
428 |
394 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
819 |
749 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
960 |
889 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,698 |
1,600 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
163 |
$21K |
| D1110 |
Prophylaxis - adult |
393 |
373 |
$19K |
| D1351 |
Sealant - per tooth |
678 |
157 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,322 |
1,224 |
$14K |
| D0274 |
Bitewings - four radiographic images |
429 |
389 |
$11K |
| D0272 |
Bitewings - two radiographic images |
150 |
144 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
47 |
43 |
$368.88 |
| D0602 |
|
1,057 |
1,012 |
$0.00 |
| D0603 |
|
1,323 |
1,272 |
$0.00 |