| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,570 |
626 |
$160K |
| D1110 |
Prophylaxis - adult |
1,775 |
1,733 |
$94K |
| D0274 |
Bitewings - four radiographic images |
1,591 |
1,567 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,763 |
1,725 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
374 |
227 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,969 |
1,932 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
799 |
773 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
388 |
374 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,044 |
2,001 |
$25K |
| D1120 |
Prophylaxis - child |
627 |
615 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,991 |
1,910 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
436 |
397 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
70 |
$11K |
| D1351 |
Sealant - per tooth |
400 |
64 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
439 |
435 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$958.58 |
| D9986 |
|
13 |
12 |
$0.00 |
| D0603 |
|
3,063 |
2,992 |
$0.00 |