| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,696 |
1,239 |
$254K |
| D1351 |
Sealant - per tooth |
6,204 |
1,494 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
4,350 |
4,252 |
$120K |
| D1120 |
Prophylaxis - child |
2,826 |
2,752 |
$99K |
| D1110 |
Prophylaxis - adult |
1,654 |
1,619 |
$87K |
| D0145 |
Oral evaluation for a patient under three years of age |
597 |
583 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,071 |
578 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,195 |
2,160 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,658 |
4,547 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,767 |
3,538 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,754 |
3,665 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
420 |
411 |
$25K |
| D0272 |
Bitewings - two radiographic images |
883 |
857 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
735 |
697 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
117 |
$4K |
| D0350 |
|
61 |
61 |
$389.21 |
| D0603 |
|
5,734 |
5,604 |
$0.00 |