| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,227 |
434 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,276 |
3,170 |
$89K |
| D1110 |
Prophylaxis - adult |
1,416 |
1,374 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,671 |
3,358 |
$62K |
| D0145 |
Oral evaluation for a patient under three years of age |
447 |
438 |
$59K |
| D1120 |
Prophylaxis - child |
1,742 |
1,681 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,492 |
3,372 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,611 |
3,507 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,093 |
1,058 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,382 |
1,352 |
$31K |
| D1351 |
Sealant - per tooth |
404 |
91 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
38 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$847.68 |
| D0603 |
|
3,762 |
3,660 |
$0.00 |
| D0602 |
|
144 |
143 |
$0.00 |