| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
690 |
240 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,563 |
1,519 |
$35K |
| D1120 |
Prophylaxis - child |
1,236 |
1,214 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,339 |
1,948 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
267 |
265 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,996 |
1,958 |
$22K |
| D1351 |
Sealant - per tooth |
1,029 |
228 |
$20K |
| D0274 |
Bitewings - four radiographic images |
927 |
902 |
$20K |
| D1110 |
Prophylaxis - adult |
483 |
480 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,099 |
1,981 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
225 |
115 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
261 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
354 |
307 |
$5K |
| D0272 |
Bitewings - two radiographic images |
157 |
155 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
55 |
$1K |
| D0603 |
|
2,646 |
2,605 |
$5.25 |