| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,022 |
1,422 |
$475K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,909 |
1,898 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
742 |
325 |
$57K |
| D1120 |
Prophylaxis - child |
1,377 |
1,364 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,755 |
2,094 |
$41K |
| D1351 |
Sealant - per tooth |
1,963 |
549 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,344 |
1,326 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,992 |
1,976 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,131 |
2,105 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,055 |
1,048 |
$23K |
| D1110 |
Prophylaxis - adult |
355 |
351 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
88 |
88 |
$11K |
| D0274 |
Bitewings - four radiographic images |
363 |
362 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
81 |
81 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D0603 |
|
2,362 |
2,311 |
$0.00 |