| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
698 |
334 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
1,187 |
$34K |
| D1120 |
Prophylaxis - child |
779 |
779 |
$28K |
| D1110 |
Prophylaxis - adult |
450 |
450 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,412 |
1,412 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
717 |
663 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,257 |
1,250 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,214 |
1,182 |
$14K |
| D0274 |
Bitewings - four radiographic images |
352 |
352 |
$12K |
| D0272 |
Bitewings - two radiographic images |
405 |
405 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
50 |
50 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
47 |
$3K |
| D1351 |
Sealant - per tooth |
105 |
37 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D0603 |
|
1,751 |
1,751 |
$0.00 |