| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
735 |
371 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
446 |
429 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,060 |
1,946 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,554 |
1,490 |
$41K |
| D1120 |
Prophylaxis - child |
1,147 |
1,099 |
$38K |
| D1110 |
Prophylaxis - adult |
634 |
613 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,036 |
976 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,174 |
2,046 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,720 |
1,650 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
142 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
545 |
505 |
$17K |
| D1351 |
Sealant - per tooth |
388 |
79 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
213 |
191 |
$5K |
| D0272 |
Bitewings - two radiographic images |
196 |
189 |
$4K |
| D1206 |
Topical application of fluoride varnish |
79 |
77 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$918.32 |
| D0603 |
|
2,789 |
2,709 |
$0.02 |