| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,624 |
1,005 |
$248K |
| D0120 |
Periodic oral evaluation - established patient |
3,848 |
3,762 |
$108K |
| D0145 |
Oral evaluation for a patient under three years of age |
672 |
662 |
$93K |
| D1120 |
Prophylaxis - child |
2,540 |
2,489 |
$90K |
| D1110 |
Prophylaxis - adult |
1,697 |
1,647 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,216 |
4,118 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,708 |
1,657 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,941 |
3,830 |
$45K |
| D1351 |
Sealant - per tooth |
1,700 |
311 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,967 |
3,766 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,854 |
1,809 |
$40K |
| D0350 |
|
2,031 |
1,924 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,219 |
1,170 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
290 |
158 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
145 |
144 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
174 |
$6K |
| D0330 |
Panoramic radiographic image |
486 |
465 |
$5K |
| D0603 |
|
5,005 |
4,914 |
$0.00 |