| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,445 |
827 |
$136K |
| D1110 |
Prophylaxis - adult |
1,545 |
1,464 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,006 |
1,901 |
$63K |
| D1351 |
Sealant - per tooth |
2,258 |
402 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,029 |
1,940 |
$55K |
| D1120 |
Prophylaxis - child |
1,232 |
1,183 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,671 |
2,555 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,313 |
1,086 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,449 |
506 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
132 |
93 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,189 |
1,084 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
417 |
369 |
$12K |
| D0330 |
Panoramic radiographic image |
112 |
102 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
40 |
$4K |
| D0272 |
Bitewings - two radiographic images |
171 |
162 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
65 |
$1K |
| D0601 |
|
1,067 |
1,031 |
$0.00 |
| D0602 |
|
500 |
483 |
$0.00 |
| D0603 |
|
1,116 |
1,057 |
$0.00 |