| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,007 |
453 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,085 |
3,152 |
$88K |
| D1351 |
Sealant - per tooth |
3,347 |
592 |
$82K |
| D1120 |
Prophylaxis - child |
1,856 |
1,821 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,157 |
2,112 |
$59K |
| D1110 |
Prophylaxis - adult |
1,120 |
1,097 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
412 |
409 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,276 |
3,218 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,191 |
1,158 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,838 |
3,693 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,228 |
1,194 |
$20K |
| D0330 |
Panoramic radiographic image |
546 |
525 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
104 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
365 |
364 |
$14K |
| D0272 |
Bitewings - two radiographic images |
411 |
405 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
99 |
95 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0603 |
|
4,618 |
4,545 |
$0.00 |