| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,117 |
1,402 |
$378K |
| D1351 |
Sealant - per tooth |
6,225 |
1,069 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,176 |
594 |
$81K |
| D1120 |
Prophylaxis - child |
2,180 |
2,083 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,581 |
2,691 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,444 |
1,358 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,912 |
2,782 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,384 |
1,344 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,554 |
1,493 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,962 |
2,783 |
$33K |
| D0274 |
Bitewings - four radiographic images |
978 |
923 |
$29K |
| D1110 |
Prophylaxis - adult |
592 |
564 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
203 |
199 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
753 |
709 |
$18K |
| D0350 |
|
1,290 |
1,239 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
90 |
85 |
$6K |
| D0330 |
Panoramic radiographic image |
141 |
138 |
$6K |
| D2330 |
|
21 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
53 |
51 |
$661.50 |
| D0240 |
|
34 |
27 |
$245.00 |
| D1330 |
|
30 |
30 |
$24.50 |
| D0601 |
|
717 |
663 |
$0.00 |
| D0603 |
|
2,577 |
2,344 |
$0.00 |
| D0602 |
|
212 |
192 |
$0.00 |