| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,272 |
2,006 |
$497K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,580 |
1,300 |
$259K |
| D0120 |
Periodic oral evaluation - established patient |
4,553 |
4,396 |
$123K |
| D0274 |
Bitewings - four radiographic images |
3,477 |
3,373 |
$112K |
| D1110 |
Prophylaxis - adult |
2,171 |
2,099 |
$111K |
| D1351 |
Sealant - per tooth |
4,124 |
1,114 |
$108K |
| D1120 |
Prophylaxis - child |
3,013 |
2,948 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,687 |
5,521 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,944 |
5,760 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,755 |
5,393 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
342 |
338 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,325 |
1,291 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
828 |
821 |
$28K |
| D2332 |
|
96 |
41 |
$13K |
| D2330 |
|
93 |
50 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$379.54 |
| D0603 |
|
5,309 |
5,192 |
$0.10 |
| D0601 |
|
589 |
584 |
$0.00 |
| D0602 |
|
14 |
13 |
$0.00 |