| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,583 |
562 |
$162K |
| D1351 |
Sealant - per tooth |
3,363 |
909 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,125 |
2,109 |
$60K |
| D1110 |
Prophylaxis - adult |
1,045 |
1,033 |
$56K |
| D1120 |
Prophylaxis - child |
1,392 |
1,385 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,726 |
2,705 |
$40K |
| D0274 |
Bitewings - four radiographic images |
722 |
713 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
292 |
153 |
$22K |
| D0272 |
Bitewings - two radiographic images |
756 |
755 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
206 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
337 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
262 |
239 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$3K |
| D0350 |
|
183 |
179 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
130 |
$2K |
| D1330 |
|
17 |
17 |
$208.25 |
| D0603 |
|
3,218 |
3,181 |
$0.00 |
| D0602 |
|
22 |
21 |
$0.00 |