| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,751 |
909 |
$376K |
| D1351 |
Sealant - per tooth |
3,604 |
747 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
3,277 |
3,228 |
$92K |
| D1120 |
Prophylaxis - child |
2,515 |
2,485 |
$90K |
| D0145 |
Oral evaluation for a patient under three years of age |
622 |
611 |
$83K |
| D1110 |
Prophylaxis - adult |
1,291 |
1,273 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,836 |
3,782 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
677 |
666 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,001 |
1,978 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
591 |
168 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,229 |
3,171 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,057 |
2,984 |
$34K |
| D0274 |
Bitewings - four radiographic images |
955 |
943 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
415 |
412 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
455 |
416 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$225.36 |
| D0601 |
|
584 |
576 |
$0.00 |
| D0603 |
|
3,462 |
3,423 |
$0.00 |
| D0602 |
|
331 |
330 |
$0.00 |