| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
358 |
186 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
201 |
199 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
841 |
835 |
$24K |
| D1120 |
Prophylaxis - child |
657 |
654 |
$23K |
| D1110 |
Prophylaxis - adult |
367 |
362 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,603 |
798 |
$18K |
| D1351 |
Sealant - per tooth |
633 |
238 |
$17K |
| D0274 |
Bitewings - four radiographic images |
462 |
459 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,022 |
1,014 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
186 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
823 |
819 |
$10K |
| D0272 |
Bitewings - two radiographic images |
328 |
327 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
175 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
212 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
48 |
$5K |
| D0603 |
|
1,346 |
1,335 |
$0.03 |