| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,084 |
1,211 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
4,033 |
3,859 |
$109K |
| D1110 |
Prophylaxis - adult |
1,972 |
1,889 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,116 |
490 |
$82K |
| D1120 |
Prophylaxis - child |
2,319 |
2,196 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,921 |
1,850 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,330 |
4,139 |
$59K |
| D0145 |
Oral evaluation for a patient under three years of age |
391 |
375 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,783 |
3,579 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
276 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,618 |
3,417 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,715 |
1,628 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
281 |
266 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
113 |
$4K |
| D1351 |
Sealant - per tooth |
78 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
43 |
$1K |
| D0603 |
|
5,039 |
4,835 |
$0.00 |