| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,910 |
832 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
3,227 |
3,050 |
$88K |
| D1352 |
|
2,510 |
630 |
$84K |
| D1120 |
Prophylaxis - child |
2,105 |
1,996 |
$72K |
| D1110 |
Prophylaxis - adult |
1,350 |
1,271 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,066 |
1,955 |
$67K |
| D1351 |
Sealant - per tooth |
2,587 |
565 |
$65K |
| D0145 |
Oral evaluation for a patient under three years of age |
421 |
410 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,452 |
3,264 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,307 |
2,014 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,761 |
1,537 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
415 |
187 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,328 |
1,246 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,370 |
2,197 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
277 |
113 |
$20K |
| D0350 |
|
877 |
816 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
12 |
$423.84 |
| D0603 |
|
4,005 |
3,714 |
$0.00 |