| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,639 |
1,150 |
$265K |
| D0145 |
Oral evaluation for a patient under three years of age |
583 |
579 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,489 |
2,472 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
878 |
505 |
$67K |
| D1120 |
Prophylaxis - child |
1,844 |
1,829 |
$67K |
| D1110 |
Prophylaxis - adult |
1,101 |
1,096 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,991 |
1,716 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,986 |
2,966 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,014 |
1,009 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,618 |
2,587 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,272 |
1,263 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,536 |
2,462 |
$29K |
| D1351 |
Sealant - per tooth |
1,060 |
293 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
275 |
272 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
298 |
296 |
$10K |
| D1330 |
|
562 |
560 |
$7K |
| D0603 |
|
3,635 |
3,600 |
$0.00 |