| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,642 |
929 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
578 |
276 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,213 |
1,199 |
$34K |
| D1351 |
Sealant - per tooth |
1,071 |
268 |
$29K |
| D1120 |
Prophylaxis - child |
729 |
722 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,511 |
1,497 |
$21K |
| D1110 |
Prophylaxis - adult |
353 |
351 |
$19K |
| D0272 |
Bitewings - two radiographic images |
674 |
667 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
388 |
371 |
$10K |
| D0274 |
Bitewings - four radiographic images |
281 |
279 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
595 |
590 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
500 |
491 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
93 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
133 |
131 |
$1K |
| D0603 |
|
503 |
502 |
$9.07 |
| D0602 |
|
913 |
906 |
$0.01 |