| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,749 |
2,561 |
$1.09M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,726 |
907 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,479 |
5,450 |
$159K |
| D1110 |
Prophylaxis - adult |
2,617 |
2,578 |
$139K |
| D0145 |
Oral evaluation for a patient under three years of age |
890 |
880 |
$124K |
| D1120 |
Prophylaxis - child |
3,463 |
3,390 |
$123K |
| D1351 |
Sealant - per tooth |
4,540 |
1,173 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,268 |
4,192 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,054 |
5,941 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,369 |
2,332 |
$80K |
| D0272 |
Bitewings - two radiographic images |
3,165 |
3,100 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,062 |
2,003 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
5,641 |
5,533 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,125 |
2,029 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
690 |
671 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
41 |
$9K |
| D0603 |
|
5,739 |
5,699 |
$0.00 |
| D0602 |
|
1,207 |
1,202 |
$0.00 |