| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
859 |
379 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,289 |
1,214 |
$34K |
| D1351 |
Sealant - per tooth |
1,240 |
277 |
$31K |
| D1110 |
Prophylaxis - adult |
593 |
557 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
398 |
235 |
$28K |
| D1120 |
Prophylaxis - child |
685 |
640 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,067 |
1,005 |
$20K |
| D0274 |
Bitewings - four radiographic images |
615 |
579 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,333 |
1,251 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,138 |
1,062 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
89 |
$12K |
| D0272 |
Bitewings - two radiographic images |
361 |
343 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
50 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$494.48 |
| D0603 |
|
1,154 |
1,087 |
$0.00 |
| D0602 |
|
194 |
186 |
$0.00 |
| D0601 |
|
28 |
27 |
$0.00 |