| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,646 |
2,668 |
$772K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,941 |
2,096 |
$462K |
| D1120 |
Prophylaxis - child |
5,006 |
4,999 |
$179K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,645 |
7,540 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,193 |
4,187 |
$143K |
| D0145 |
Oral evaluation for a patient under three years of age |
886 |
886 |
$124K |
| D1110 |
Prophylaxis - adult |
2,193 |
2,190 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,248 |
7,237 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,015 |
3,011 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
7,583 |
7,564 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,257 |
3,253 |
$92K |
| D1351 |
Sealant - per tooth |
3,423 |
862 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,059 |
2,054 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,909 |
1,907 |
$44K |
| D1330 |
|
95 |
94 |
$830.56 |
| D0603 |
|
8,461 |
8,450 |
$0.00 |