| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
185 |
97 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
117 |
$15K |
| D1351 |
Sealant - per tooth |
517 |
156 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,200 |
451 |
$13K |
| D1120 |
Prophylaxis - child |
312 |
310 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
250 |
$9K |
| D1110 |
Prophylaxis - adult |
148 |
148 |
$8K |
| D0274 |
Bitewings - four radiographic images |
232 |
232 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
460 |
458 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
47 |
47 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
213 |
212 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
466 |
460 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
190 |
187 |
$5K |
| D0272 |
Bitewings - two radiographic images |
122 |
120 |
$3K |
| D0603 |
|
513 |
511 |
$0.00 |