| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
885 |
280 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,872 |
1,817 |
$45K |
| D1120 |
Prophylaxis - child |
1,425 |
1,376 |
$45K |
| D1110 |
Prophylaxis - adult |
653 |
639 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,103 |
2,032 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,052 |
1,002 |
$26K |
| D1351 |
Sealant - per tooth |
1,156 |
247 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,178 |
2,090 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
179 |
178 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,112 |
1,982 |
$21K |
| D0272 |
Bitewings - two radiographic images |
807 |
778 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
478 |
417 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
51 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
83 |
$3K |
| D0603 |
|
735 |
716 |
$33.00 |
| D0602 |
|
1,570 |
1,532 |
$33.00 |