| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,668 |
676 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
776 |
363 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,986 |
1,965 |
$56K |
| D1110 |
Prophylaxis - adult |
1,026 |
1,007 |
$54K |
| D1120 |
Prophylaxis - child |
1,369 |
1,351 |
$48K |
| D1351 |
Sealant - per tooth |
1,470 |
425 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,476 |
2,437 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,106 |
1,086 |
$33K |
| D0350 |
|
1,527 |
1,496 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,977 |
1,941 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,143 |
1,732 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
140 |
$20K |
| D0272 |
Bitewings - two radiographic images |
841 |
835 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
614 |
567 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
387 |
$13K |
| D0330 |
Panoramic radiographic image |
267 |
263 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
54 |
$4K |
| D0602 |
|
978 |
966 |
$0.00 |
| D0603 |
|
1,987 |
1,949 |
$0.00 |