| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,175 |
909 |
$317K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,582 |
524 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,942 |
1,689 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,629 |
1,614 |
$49K |
| D1120 |
Prophylaxis - child |
1,140 |
1,124 |
$40K |
| D1351 |
Sealant - per tooth |
1,208 |
300 |
$31K |
| D1110 |
Prophylaxis - adult |
584 |
580 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,724 |
1,703 |
$25K |
| D0274 |
Bitewings - four radiographic images |
720 |
717 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,709 |
1,690 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
150 |
147 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
689 |
680 |
$18K |
| D2330 |
|
139 |
72 |
$10K |
| D0272 |
Bitewings - two radiographic images |
453 |
450 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
260 |
258 |
$7K |
| D0603 |
|
2,102 |
1,904 |
$0.00 |