| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,742 |
872 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
1,997 |
1,972 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
401 |
394 |
$55K |
| D1110 |
Prophylaxis - adult |
803 |
791 |
$43K |
| D1120 |
Prophylaxis - child |
1,197 |
1,178 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,383 |
1,075 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,135 |
2,105 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,355 |
2,211 |
$28K |
| D0274 |
Bitewings - four radiographic images |
793 |
781 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,049 |
1,028 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,102 |
2,041 |
$23K |
| D0330 |
Panoramic radiographic image |
237 |
236 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
78 |
$14K |
| D1351 |
Sealant - per tooth |
472 |
85 |
$13K |
| D1330 |
|
493 |
488 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$751.20 |
| D0603 |
|
2,027 |
1,998 |
$0.00 |
| D0602 |
|
69 |
67 |
$0.00 |
| D0601 |
|
65 |
64 |
$0.00 |