| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,094 |
570 |
$191K |
| D1351 |
Sealant - per tooth |
2,088 |
366 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
742 |
242 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,665 |
1,626 |
$46K |
| D1110 |
Prophylaxis - adult |
869 |
855 |
$45K |
| D1120 |
Prophylaxis - child |
1,126 |
1,098 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
496 |
485 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,129 |
1,050 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,962 |
1,918 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,555 |
1,506 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
133 |
132 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
695 |
622 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,433 |
1,383 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
283 |
$9K |
| D0272 |
Bitewings - two radiographic images |
269 |
265 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
14 |
$507.48 |
| D0603 |
|
1,891 |
1,844 |
$0.00 |
| D0601 |
|
130 |
128 |
$0.00 |
| D0602 |
|
249 |
247 |
$0.00 |