| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,091 |
464 |
$107K |
| D0145 |
Oral evaluation for a patient under three years of age |
692 |
681 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,559 |
2,482 |
$71K |
| D1120 |
Prophylaxis - child |
1,971 |
1,926 |
$70K |
| D1351 |
Sealant - per tooth |
2,281 |
605 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,161 |
2,597 |
$56K |
| D1110 |
Prophylaxis - adult |
919 |
893 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,889 |
2,814 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,116 |
1,069 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,820 |
2,723 |
$34K |
| D0272 |
Bitewings - two radiographic images |
881 |
863 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
573 |
544 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
163 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$906.29 |
| D0603 |
|
3,600 |
3,524 |
$0.00 |