| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,311 |
441 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
2,194 |
2,181 |
$58K |
| D1120 |
Prophylaxis - child |
1,743 |
1,725 |
$58K |
| D1351 |
Sealant - per tooth |
1,938 |
484 |
$50K |
| D0145 |
Oral evaluation for a patient under three years of age |
376 |
374 |
$49K |
| D1110 |
Prophylaxis - adult |
778 |
776 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,332 |
2,316 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,008 |
1,002 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,658 |
2,620 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,295 |
1,286 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,558 |
2,527 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
769 |
717 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
150 |
148 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
13 |
$2K |
| D0602 |
|
1,802 |
1,792 |
$33.00 |
| D0603 |
|
1,199 |
1,191 |
$33.00 |
| D1999 |
|
2,669 |
2,650 |
$0.00 |
| D1310 |
|
53 |
53 |
$0.00 |
| D1330 |
|
53 |
53 |
$0.00 |