| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,839 |
2,033 |
$693K |
| D0210 |
Intraoral - complete series of radiographic images |
1,816 |
1,798 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,286 |
790 |
$100K |
| D1351 |
Sealant - per tooth |
2,973 |
811 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
713 |
421 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,160 |
2,136 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,206 |
2,181 |
$59K |
| D1120 |
Prophylaxis - child |
1,474 |
1,458 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
312 |
309 |
$43K |
| D1110 |
Prophylaxis - adult |
732 |
727 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,206 |
2,185 |
$32K |
| D2332 |
|
191 |
129 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,805 |
414 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
429 |
421 |
$5K |
| D2330 |
|
54 |
37 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
44 |
44 |
$1K |
| D0603 |
|
2,569 |
2,544 |
$0.00 |