| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
69 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
493 |
451 |
$13K |
| D1120 |
Prophylaxis - child |
417 |
370 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
760 |
677 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
687 |
609 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
642 |
560 |
$6K |
| D0272 |
Bitewings - two radiographic images |
281 |
248 |
$6K |
| D1110 |
Prophylaxis - adult |
108 |
87 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
116 |
$4K |
| D0274 |
Bitewings - four radiographic images |
107 |
89 |
$3K |
| D1351 |
Sealant - per tooth |
97 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$1K |
| D0603 |
|
681 |
593 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |
| D0602 |
|
91 |
88 |
$0.00 |