| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,081 |
5,167 |
$1.50M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,929 |
5,159 |
$926K |
| D2331 |
|
3,245 |
2,087 |
$314K |
| D1351 |
Sealant - per tooth |
9,378 |
2,819 |
$248K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,653 |
4,625 |
$158K |
| D1120 |
Prophylaxis - child |
4,334 |
4,303 |
$155K |
| D1110 |
Prophylaxis - adult |
2,630 |
2,619 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,051 |
7,006 |
$102K |
| D0272 |
Bitewings - two radiographic images |
4,335 |
4,304 |
$100K |
| D0145 |
Oral evaluation for a patient under three years of age |
675 |
672 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,603 |
2,593 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
7,060 |
7,004 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,046 |
6,983 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,353 |
2,338 |
$67K |
| D0350 |
|
4,344 |
4,305 |
$62K |
| D2330 |
|
126 |
88 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
151 |
150 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$1K |
| D1352 |
|
53 |
32 |
$287.20 |
| D0602 |
|
7,872 |
7,826 |
$0.00 |