| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
880 |
253 |
$86K |
| D1120 |
Prophylaxis - child |
1,487 |
1,476 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,786 |
1,775 |
$50K |
| D1351 |
Sealant - per tooth |
1,243 |
304 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,361 |
2,345 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,917 |
1,887 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,805 |
1,650 |
$20K |
| D1110 |
Prophylaxis - adult |
325 |
323 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
124 |
124 |
$17K |
| D0274 |
Bitewings - four radiographic images |
409 |
407 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
193 |
$13K |
| D0272 |
Bitewings - two radiographic images |
542 |
536 |
$12K |
| D9248 |
|
31 |
31 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
68 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$323.24 |
| D0603 |
|
1,983 |
1,976 |
$0.00 |
| D0601 |
|
190 |
190 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |