| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,736 |
1,633 |
$365K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,273 |
1,253 |
$216K |
| D1351 |
Sealant - per tooth |
7,191 |
2,127 |
$190K |
| D1120 |
Prophylaxis - child |
3,317 |
3,261 |
$119K |
| D1110 |
Prophylaxis - adult |
2,121 |
2,101 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,786 |
3,749 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,955 |
4,588 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,512 |
2,487 |
$85K |
| D0145 |
Oral evaluation for a patient under three years of age |
573 |
562 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,441 |
5,366 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,124 |
1,106 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,675 |
1,631 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,764 |
4,679 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,681 |
1,649 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
115 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$2K |
| D1352 |
|
85 |
27 |
$1K |
| D0603 |
|
5,520 |
5,465 |
$0.00 |
| D0602 |
|
174 |
170 |
$0.00 |