| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,039 |
442 |
$88K |
| D1110 |
Prophylaxis - adult |
1,418 |
1,368 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,128 |
2,066 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,724 |
1,667 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,363 |
2,293 |
$32K |
| D1120 |
Prophylaxis - child |
975 |
954 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,500 |
2,413 |
$28K |
| D1351 |
Sealant - per tooth |
1,028 |
188 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,425 |
2,311 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
73 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
269 |
234 |
$7K |
| D0272 |
Bitewings - two radiographic images |
275 |
268 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
107 |
$3K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$257.81 |
| D0603 |
|
1,205 |
1,171 |
$0.00 |
| D0601 |
|
840 |
819 |
$0.00 |
| D0602 |
|
181 |
180 |
$0.00 |