| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,439 |
724 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
2,552 |
2,532 |
$71K |
| D0145 |
Oral evaluation for a patient under three years of age |
441 |
436 |
$60K |
| D1351 |
Sealant - per tooth |
2,107 |
555 |
$57K |
| D1120 |
Prophylaxis - child |
1,590 |
1,580 |
$56K |
| D1110 |
Prophylaxis - adult |
1,013 |
1,001 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,723 |
2,699 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,051 |
982 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
227 |
$25K |
| D0274 |
Bitewings - four radiographic images |
625 |
614 |
$20K |
| D0272 |
Bitewings - two radiographic images |
544 |
537 |
$12K |
| D0330 |
Panoramic radiographic image |
228 |
221 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
98 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
140 |
$2K |
| D0603 |
|
3,480 |
3,433 |
$0.00 |