| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,842 |
1,740 |
$258K |
| D0120 |
Periodic oral evaluation - established patient |
7,179 |
6,887 |
$195K |
| D1110 |
Prophylaxis - adult |
3,812 |
3,657 |
$195K |
| D0274 |
Bitewings - four radiographic images |
4,730 |
4,528 |
$150K |
| D1120 |
Prophylaxis - child |
3,551 |
3,410 |
$122K |
| D1206 |
Topical application of fluoride varnish |
7,196 |
6,904 |
$100K |
| D1351 |
Sealant - per tooth |
3,846 |
751 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,067 |
2,564 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
775 |
580 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,180 |
2,090 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
129 |
$17K |
| D0330 |
Panoramic radiographic image |
316 |
294 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
713 |
679 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
733 |
615 |
$8K |
| D0601 |
|
1,648 |
1,576 |
$0.00 |
| D0603 |
|
2,477 |
2,388 |
$0.00 |
| D0602 |
|
3,592 |
3,456 |
$0.00 |