| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,218 |
757 |
$114K |
| D1351 |
Sealant - per tooth |
3,307 |
862 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,713 |
2,702 |
$78K |
| D1120 |
Prophylaxis - child |
1,898 |
1,893 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
907 |
606 |
$66K |
| D1110 |
Prophylaxis - adult |
1,092 |
1,084 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,671 |
1,661 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
337 |
333 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,992 |
2,979 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,700 |
2,678 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,552 |
2,526 |
$29K |
| D0272 |
Bitewings - two radiographic images |
744 |
743 |
$17K |
| D0330 |
Panoramic radiographic image |
668 |
664 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
115 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
50 |
$769.98 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
14 |
$406.65 |
| D0601 |
|
349 |
344 |
$0.00 |
| D0603 |
|
4,322 |
3,830 |
$0.00 |