| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,415 |
641 |
$127K |
| D1120 |
Prophylaxis - child |
2,619 |
2,510 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,262 |
3,142 |
$88K |
| D0272 |
Bitewings - two radiographic images |
2,255 |
2,156 |
$49K |
| D1110 |
Prophylaxis - adult |
816 |
786 |
$42K |
| D1351 |
Sealant - per tooth |
1,674 |
446 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,215 |
2,184 |
$32K |
| D0274 |
Bitewings - four radiographic images |
881 |
857 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
924 |
834 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
135 |
$18K |
| D9248 |
|
149 |
142 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
107 |
$14K |
| D1206 |
Topical application of fluoride varnish |
932 |
861 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
703 |
645 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
128 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
350 |
317 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$1K |
| D0603 |
|
3,789 |
3,677 |
$0.00 |
| D1999 |
|
265 |
246 |
$0.00 |