| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
437 |
130 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
291 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
33 |
$9K |
| D1351 |
Sealant - per tooth |
284 |
72 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
548 |
174 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
57 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
136 |
134 |
$4K |
| D1120 |
Prophylaxis - child |
82 |
82 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
180 |
$2K |
| D0274 |
Bitewings - four radiographic images |
59 |
59 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
126 |
126 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D1330 |
|
95 |
93 |
$1K |
| D0603 |
|
467 |
465 |
$0.00 |