| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
972 |
384 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,172 |
3,129 |
$89K |
| D1120 |
Prophylaxis - child |
2,211 |
2,176 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
514 |
508 |
$69K |
| D1110 |
Prophylaxis - adult |
1,173 |
1,158 |
$62K |
| D1351 |
Sealant - per tooth |
2,024 |
443 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,642 |
3,592 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,760 |
1,732 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,042 |
2,995 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,110 |
2,918 |
$35K |
| D0274 |
Bitewings - four radiographic images |
837 |
824 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
49 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
131 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
64 |
$4K |
| D0601 |
|
2,777 |
2,735 |
$0.03 |
| D0603 |
|
1,372 |
1,361 |
$0.00 |