| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,940 |
617 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
2,425 |
2,355 |
$67K |
| D1351 |
Sealant - per tooth |
2,271 |
451 |
$59K |
| D1110 |
Prophylaxis - adult |
953 |
919 |
$49K |
| D1120 |
Prophylaxis - child |
1,364 |
1,340 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
271 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,423 |
1,377 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,674 |
2,603 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
880 |
838 |
$22K |
| D0272 |
Bitewings - two radiographic images |
619 |
610 |
$13K |
| D0330 |
Panoramic radiographic image |
272 |
263 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
187 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
37 |
37 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$1K |
| D0240 |
|
120 |
63 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$225.36 |
| D7111 |
|
14 |
12 |
$160.58 |
| D1999 |
|
367 |
354 |
$0.00 |
| D0603 |
|
2,663 |
2,607 |
$0.00 |
| D0602 |
|
89 |
89 |
$0.00 |