| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,457 |
4,925 |
$1.48M |
| D1351 |
Sealant - per tooth |
16,857 |
3,706 |
$458K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,261 |
5,233 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,279 |
1,608 |
$180K |
| D1120 |
Prophylaxis - child |
4,232 |
4,207 |
$154K |
| D0274 |
Bitewings - four radiographic images |
3,935 |
3,916 |
$135K |
| D1110 |
Prophylaxis - adult |
2,244 |
2,231 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,585 |
6,547 |
$96K |
| D0145 |
Oral evaluation for a patient under three years of age |
672 |
670 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,612 |
6,564 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,604 |
6,548 |
$75K |
| D0272 |
Bitewings - two radiographic images |
2,549 |
2,535 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,341 |
1,333 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
162 |
65 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
108 |
107 |
$3K |
| D0603 |
|
7,279 |
7,241 |
$0.00 |