| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,193 |
471 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
2,227 |
2,164 |
$61K |
| D1120 |
Prophylaxis - child |
1,706 |
1,667 |
$58K |
| D0145 |
Oral evaluation for a patient under three years of age |
415 |
408 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
700 |
286 |
$52K |
| D1110 |
Prophylaxis - adult |
920 |
887 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,567 |
2,494 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,297 |
1,265 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,261 |
2,194 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,297 |
2,077 |
$24K |
| D0274 |
Bitewings - four radiographic images |
607 |
590 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
794 |
699 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
356 |
$12K |
| D1351 |
Sealant - per tooth |
441 |
56 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
138 |
$9K |
| D0603 |
|
3,223 |
3,126 |
$0.00 |