| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
976 |
340 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
463 |
208 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
536 |
526 |
$18K |
| D1351 |
Sealant - per tooth |
666 |
186 |
$17K |
| D1120 |
Prophylaxis - child |
341 |
336 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
986 |
551 |
$11K |
| D1110 |
Prophylaxis - adult |
199 |
193 |
$11K |
| D0274 |
Bitewings - four radiographic images |
265 |
260 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
570 |
559 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
567 |
556 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
254 |
251 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$4K |
| D0272 |
Bitewings - two radiographic images |
163 |
158 |
$4K |
| D0602 |
|
219 |
213 |
$0.00 |
| D0603 |
|
381 |
373 |
$0.00 |