| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,178 |
520 |
$93K |
| D1351 |
Sealant - per tooth |
2,552 |
561 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,044 |
1,873 |
$51K |
| D1110 |
Prophylaxis - adult |
975 |
906 |
$45K |
| D1120 |
Prophylaxis - child |
1,550 |
1,389 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
363 |
344 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,566 |
2,336 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
441 |
256 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,540 |
1,406 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,885 |
2,443 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,909 |
2,221 |
$21K |
| D0274 |
Bitewings - four radiographic images |
888 |
761 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
536 |
452 |
$15K |
| D0330 |
Panoramic radiographic image |
461 |
377 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
316 |
274 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
72 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$847.68 |
| D0603 |
|
3,504 |
3,196 |
$0.00 |