| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,215 |
701 |
$221K |
| D1120 |
Prophylaxis - child |
3,824 |
3,813 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
3,676 |
3,669 |
$191K |
| D0277 |
|
1,659 |
1,652 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,532 |
3,520 |
$110K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,450 |
1,335 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
253 |
163 |
$34K |
| D0602 |
|
2,144 |
2,135 |
$13K |
| D0603 |
|
2,038 |
2,035 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
141 |
$9K |
| D0240 |
|
245 |
136 |
$8K |
| D0330 |
Panoramic radiographic image |
72 |
70 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
25 |
$4K |
| D1351 |
Sealant - per tooth |
78 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$2K |
| D1999 |
|
1,198 |
1,134 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
70 |
$2K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$873.00 |
| D0251 |
|
13 |
13 |
$807.26 |
| D1310 |
|
125 |
125 |
$79.50 |
| D1330 |
|
125 |
125 |
$0.00 |