| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,405 |
956 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
3,218 |
3,166 |
$90K |
| D1120 |
Prophylaxis - child |
1,980 |
1,943 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,346 |
2,961 |
$70K |
| D1110 |
Prophylaxis - adult |
1,130 |
1,119 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,631 |
1,607 |
$55K |
| D1351 |
Sealant - per tooth |
1,870 |
533 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,359 |
3,302 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,266 |
3,198 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
212 |
211 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
743 |
706 |
$19K |
| D0272 |
Bitewings - two radiographic images |
574 |
562 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
43 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
50 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$1K |
| D0603 |
|
3,861 |
3,799 |
$0.00 |
| D0602 |
|
35 |
35 |
$0.00 |