| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,655 |
951 |
$263K |
| D1351 |
Sealant - per tooth |
6,105 |
1,466 |
$160K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,566 |
4,804 |
$99K |
| D1120 |
Prophylaxis - child |
2,537 |
2,507 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,943 |
2,911 |
$82K |
| D1110 |
Prophylaxis - adult |
1,555 |
1,534 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,792 |
4,740 |
$64K |
| D0145 |
Oral evaluation for a patient under three years of age |
405 |
401 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,644 |
1,610 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,898 |
1,866 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
5,081 |
4,988 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
615 |
336 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,211 |
1,200 |
$25K |
| D0330 |
Panoramic radiographic image |
528 |
521 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
42 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
105 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
215 |
201 |
$6K |
| D9248 |
|
17 |
16 |
$2K |
| D0603 |
|
6,224 |
6,136 |
$0.00 |