| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,401 |
5,336 |
$1.08M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,623 |
3,568 |
$487K |
| D1351 |
Sealant - per tooth |
17,044 |
4,383 |
$430K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,286 |
10,690 |
$268K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,098 |
7,902 |
$265K |
| D1120 |
Prophylaxis - child |
7,065 |
6,939 |
$245K |
| D0274 |
Bitewings - four radiographic images |
6,113 |
5,973 |
$196K |
| D1110 |
Prophylaxis - adult |
3,678 |
3,576 |
$188K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,864 |
10,612 |
$151K |
| D0220 |
Intraoral - periapical first radiographic image |
11,138 |
10,750 |
$129K |
| D0145 |
Oral evaluation for a patient under three years of age |
733 |
712 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,848 |
2,788 |
$78K |
| D0272 |
Bitewings - two radiographic images |
2,577 |
2,525 |
$57K |
| D2332 |
|
442 |
243 |
$52K |
| D2330 |
|
116 |
54 |
$7K |
| D0330 |
Panoramic radiographic image |
147 |
142 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
50 |
$3K |
| D1206 |
Topical application of fluoride varnish |
126 |
124 |
$2K |
| D1352 |
|
27 |
15 |
$149.76 |
| D0602 |
|
3,490 |
3,434 |
$0.00 |
| D0603 |
|
7,268 |
7,074 |
$0.00 |
| D0601 |
|
1,023 |
998 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
30 |
30 |
$0.00 |
| D1999 |
|
459 |
446 |
$0.00 |