| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
715 |
314 |
$66K |
| D1351 |
Sealant - per tooth |
1,970 |
424 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,674 |
1,589 |
$44K |
| D1110 |
Prophylaxis - adult |
904 |
858 |
$43K |
| D1120 |
Prophylaxis - child |
1,103 |
1,041 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,034 |
966 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,941 |
1,842 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,172 |
1,673 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,910 |
1,780 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
150 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
712 |
640 |
$18K |
| D0272 |
Bitewings - two radiographic images |
388 |
378 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
140 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
63 |
62 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
163 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
72 |
$949.62 |
| D0350 |
|
73 |
66 |
$896.94 |
| D0602 |
|
369 |
346 |
$0.00 |
| D0603 |
|
1,657 |
1,527 |
$0.00 |
| D0601 |
|
63 |
61 |
$0.00 |