| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
515 |
232 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
910 |
890 |
$25K |
| D1120 |
Prophylaxis - child |
644 |
631 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
304 |
172 |
$22K |
| D1351 |
Sealant - per tooth |
897 |
203 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,635 |
895 |
$17K |
| D1110 |
Prophylaxis - adult |
312 |
305 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
112 |
$15K |
| D0274 |
Bitewings - four radiographic images |
423 |
414 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
970 |
952 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
971 |
942 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
240 |
219 |
$6K |
| D0272 |
Bitewings - two radiographic images |
233 |
230 |
$5K |
| D0603 |
|
1,149 |
1,140 |
$0.00 |