| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,542 |
389 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
836 |
257 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,720 |
550 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
561 |
559 |
$19K |
| D1120 |
Prophylaxis - child |
376 |
375 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
411 |
408 |
$11K |
| D2330 |
|
136 |
69 |
$10K |
| D1110 |
Prophylaxis - adult |
180 |
179 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
566 |
563 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
548 |
$7K |
| D0274 |
Bitewings - four radiographic images |
180 |
179 |
$6K |
| D1351 |
Sealant - per tooth |
179 |
51 |
$5K |
| D0272 |
Bitewings - two radiographic images |
145 |
143 |
$3K |
| D0603 |
|
628 |
618 |
$0.00 |