| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,411 |
793 |
$131K |
| D1351 |
Sealant - per tooth |
4,902 |
1,208 |
$129K |
| D1120 |
Prophylaxis - child |
3,100 |
3,050 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,420 |
3,354 |
$93K |
| D0145 |
Oral evaluation for a patient under three years of age |
642 |
636 |
$89K |
| D1110 |
Prophylaxis - adult |
1,442 |
1,411 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,803 |
4,713 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
701 |
429 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
606 |
594 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,183 |
1,162 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,682 |
1,646 |
$37K |
| D0274 |
Bitewings - four radiographic images |
956 |
931 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
199 |
99 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
955 |
907 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,056 |
2,011 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,229 |
1,851 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
27 |
$3K |
| D0603 |
|
4,559 |
4,496 |
$0.00 |
| D0602 |
|
840 |
831 |
$0.00 |