| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,667 |
754 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,598 |
737 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,790 |
1,783 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,371 |
2,312 |
$49K |
| D1120 |
Prophylaxis - child |
1,032 |
1,030 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,029 |
1,026 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,331 |
2,324 |
$28K |
| D1110 |
Prophylaxis - adult |
547 |
545 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
865 |
861 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,640 |
1,637 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
112 |
$16K |
| D0272 |
Bitewings - two radiographic images |
602 |
600 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
386 |
386 |
$11K |
| D1351 |
Sealant - per tooth |
330 |
48 |
$9K |
| D2330 |
|
34 |
18 |
$3K |
| D1330 |
|
130 |
130 |
$1K |
| D0603 |
|
2,446 |
2,441 |
$0.00 |