| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
6,613 |
2,181 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,317 |
2,236 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
279 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
827 |
354 |
$62K |
| D1120 |
Prophylaxis - child |
1,413 |
1,394 |
$50K |
| D1351 |
Sealant - per tooth |
1,794 |
471 |
$45K |
| D1110 |
Prophylaxis - adult |
886 |
832 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,311 |
2,244 |
$33K |
| D0274 |
Bitewings - four radiographic images |
878 |
824 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,315 |
2,215 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
447 |
430 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
44 |
44 |
$6K |
| D0272 |
Bitewings - two radiographic images |
161 |
160 |
$4K |
| D0603 |
|
2,626 |
2,557 |
$0.00 |