| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,213 |
441 |
$116K |
| D1351 |
Sealant - per tooth |
2,566 |
561 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,042 |
2,022 |
$57K |
| D1120 |
Prophylaxis - child |
1,420 |
1,402 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,545 |
2,518 |
$36K |
| D1110 |
Prophylaxis - adult |
537 |
532 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,885 |
1,864 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,012 |
997 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,912 |
1,657 |
$20K |
| D0274 |
Bitewings - four radiographic images |
592 |
588 |
$17K |
| D0350 |
|
1,008 |
983 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
112 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
404 |
391 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
162 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
27 |
$4K |
| D0330 |
Panoramic radiographic image |
102 |
101 |
$3K |
| D0602 |
|
1,358 |
1,346 |
$0.00 |
| D0603 |
|
1,180 |
1,167 |
$0.00 |