| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,075 |
1,399 |
$305K |
| D1351 |
Sealant - per tooth |
6,354 |
1,412 |
$174K |
| D1120 |
Prophylaxis - child |
3,537 |
3,448 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,077 |
3,989 |
$114K |
| D0145 |
Oral evaluation for a patient under three years of age |
772 |
761 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,839 |
2,790 |
$95K |
| D1110 |
Prophylaxis - adult |
1,764 |
1,738 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,092 |
533 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,540 |
5,422 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,124 |
5,323 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,782 |
5,642 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,170 |
1,140 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,649 |
1,620 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
150 |
136 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D0603 |
|
4,485 |
4,430 |
$0.00 |
| D0602 |
|
1,764 |
1,736 |
$0.00 |
| D0601 |
|
26 |
24 |
$0.00 |