| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,335 |
931 |
$194K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,364 |
862 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
1,936 |
1,789 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,980 |
1,821 |
$62K |
| D1351 |
Sealant - per tooth |
2,662 |
573 |
$53K |
| D1120 |
Prophylaxis - child |
1,277 |
1,186 |
$40K |
| D1110 |
Prophylaxis - adult |
794 |
738 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,529 |
1,394 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,054 |
1,901 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
189 |
177 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
94 |
72 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
133 |
64 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
135 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
103 |
103 |
$3K |
| D0274 |
Bitewings - four radiographic images |
65 |
65 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
138 |
$2K |
| D0272 |
Bitewings - two radiographic images |
23 |
23 |
$444.22 |
| D0330 |
Panoramic radiographic image |
42 |
40 |
$318.90 |
| D0350 |
|
42 |
35 |
$314.26 |
| D0603 |
|
2,227 |
2,074 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0601 |
|
29 |
29 |
$0.00 |