| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,970 |
968 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
1,999 |
1,995 |
$57K |
| D1110 |
Prophylaxis - adult |
1,001 |
999 |
$54K |
| D1120 |
Prophylaxis - child |
1,409 |
1,406 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
595 |
378 |
$47K |
| D1351 |
Sealant - per tooth |
1,636 |
633 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,484 |
1,368 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,471 |
2,466 |
$36K |
| D0274 |
Bitewings - four radiographic images |
904 |
902 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,130 |
2,116 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,004 |
1,978 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
138 |
136 |
$19K |
| D0272 |
Bitewings - two radiographic images |
745 |
743 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
229 |
229 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
236 |
$8K |
| D0603 |
|
2,941 |
2,935 |
$0.00 |