| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,323 |
365 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,116 |
1,264 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
262 |
260 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,309 |
1,292 |
$35K |
| D1120 |
Prophylaxis - child |
947 |
936 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
464 |
148 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,821 |
1,798 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,391 |
1,354 |
$16K |
| D1110 |
Prophylaxis - adult |
205 |
199 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
318 |
307 |
$8K |
| D0274 |
Bitewings - four radiographic images |
129 |
125 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
64 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
113 |
$3K |
| D0272 |
Bitewings - two radiographic images |
120 |
119 |
$3K |
| D2330 |
|
30 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
100 |
24 |
$2K |
| D0603 |
|
2,574 |
2,527 |
$0.00 |