| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,459 |
1,126 |
$293K |
| D1110 |
Prophylaxis - adult |
2,284 |
1,956 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
4,107 |
3,576 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,351 |
2,030 |
$67K |
| D1120 |
Prophylaxis - child |
1,995 |
1,775 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,453 |
3,896 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
636 |
268 |
$40K |
| D1351 |
Sealant - per tooth |
1,747 |
337 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
250 |
222 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,034 |
912 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
823 |
287 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
511 |
440 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
16 |
$569.31 |
| D0330 |
Panoramic radiographic image |
15 |
12 |
$554.57 |
| D1330 |
|
71 |
69 |
$12.25 |
| D0603 |
|
4,216 |
3,697 |
$0.00 |
| D0602 |
|
211 |
185 |
$0.00 |
| D0601 |
|
64 |
51 |
$0.00 |