| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,335 |
1,724 |
$524K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,127 |
764 |
$153K |
| D0145 |
Oral evaluation for a patient under three years of age |
843 |
836 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,570 |
3,051 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,165 |
3,139 |
$89K |
| D1120 |
Prophylaxis - child |
2,439 |
2,422 |
$87K |
| D1110 |
Prophylaxis - adult |
1,228 |
1,216 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,039 |
4,007 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,532 |
1,476 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,282 |
3,245 |
$40K |
| D0274 |
Bitewings - four radiographic images |
995 |
982 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
464 |
459 |
$31K |
| D0272 |
Bitewings - two radiographic images |
980 |
976 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
548 |
542 |
$18K |
| D2330 |
|
182 |
64 |
$13K |
| D1352 |
|
214 |
77 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
29 |
$6K |
| D1351 |
Sealant - per tooth |
138 |
41 |
$4K |
| D0603 |
|
5,303 |
5,228 |
$0.00 |