| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,370 |
446 |
$137K |
| D1351 |
Sealant - per tooth |
3,516 |
887 |
$96K |
| D0145 |
Oral evaluation for a patient under three years of age |
558 |
552 |
$77K |
| D1120 |
Prophylaxis - child |
2,000 |
1,966 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,416 |
2,364 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,008 |
2,963 |
$43K |
| D1110 |
Prophylaxis - adult |
541 |
538 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,237 |
1,202 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,056 |
1,050 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,481 |
1,178 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,496 |
1,432 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
241 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
46 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
67 |
$2K |
| D9248 |
|
13 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
37 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$244.14 |
| D0603 |
|
4,119 |
4,029 |
$9.12 |