| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
709 |
246 |
$65K |
| D1351 |
Sealant - per tooth |
1,469 |
367 |
$40K |
| D1120 |
Prophylaxis - child |
993 |
979 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
205 |
205 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
914 |
898 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,139 |
1,129 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
105 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,446 |
1,419 |
$21K |
| D1110 |
Prophylaxis - adult |
380 |
371 |
$20K |
| D0274 |
Bitewings - four radiographic images |
539 |
529 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
496 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,203 |
1,176 |
$15K |
| D0272 |
Bitewings - two radiographic images |
441 |
430 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
177 |
165 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
41 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$3K |
| D0602 |
|
240 |
240 |
$0.00 |
| D0603 |
|
1,386 |
1,362 |
$0.00 |