| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,338 |
482 |
$101K |
| D1110 |
Prophylaxis - adult |
1,869 |
1,836 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
771 |
295 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,467 |
2,419 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,362 |
2,314 |
$50K |
| D1120 |
Prophylaxis - child |
1,296 |
1,271 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,169 |
1,153 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
820 |
731 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,889 |
1,851 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
633 |
626 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,828 |
1,777 |
$18K |
| D1206 |
Topical application of fluoride varnish |
515 |
506 |
$10K |
| D1351 |
Sealant - per tooth |
73 |
25 |
$3K |
| D2394 |
|
21 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
103 |
103 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |