| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,550 |
982 |
$253K |
| D1351 |
Sealant - per tooth |
3,602 |
1,034 |
$97K |
| D0145 |
Oral evaluation for a patient under three years of age |
595 |
589 |
$82K |
| D1120 |
Prophylaxis - child |
1,911 |
1,892 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,025 |
2,010 |
$57K |
| D1110 |
Prophylaxis - adult |
851 |
835 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,280 |
1,261 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
516 |
300 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,715 |
2,687 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,727 |
2,682 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,185 |
1,148 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,741 |
2,477 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,204 |
1,197 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
699 |
681 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
104 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
18 |
$244.14 |
| D0270 |
|
14 |
14 |
$67.62 |
| D0603 |
|
3,552 |
3,513 |
$33.00 |