| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,184 |
825 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,071 |
553 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
801 |
758 |
$45K |
| D1351 |
Sealant - per tooth |
1,731 |
464 |
$39K |
| D1120 |
Prophylaxis - child |
1,174 |
1,121 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,187 |
1,108 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,923 |
880 |
$28K |
| D1110 |
Prophylaxis - adult |
531 |
497 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
935 |
892 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,713 |
1,628 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
181 |
169 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
537 |
529 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
935 |
887 |
$10K |
| D0274 |
Bitewings - four radiographic images |
315 |
302 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
49 |
$7K |
| D0272 |
Bitewings - two radiographic images |
183 |
172 |
$3K |
| D7111 |
|
18 |
14 |
$206.46 |
| D0603 |
|
1,885 |
1,786 |
$0.00 |
| D0602 |
|
35 |
34 |
$0.00 |