| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,796 |
822 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
3,155 |
3,141 |
$90K |
| D1351 |
Sealant - per tooth |
3,336 |
772 |
$89K |
| D1120 |
Prophylaxis - child |
2,090 |
2,084 |
$75K |
| D1110 |
Prophylaxis - adult |
1,037 |
1,029 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
366 |
366 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,452 |
3,435 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
645 |
344 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,209 |
1,197 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,961 |
2,941 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,224 |
2,784 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,085 |
1,033 |
$29K |
| D0272 |
Bitewings - two radiographic images |
832 |
829 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
172 |
172 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
67 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$464.80 |
| D0603 |
|
3,384 |
3,368 |
$0.00 |
| D0602 |
|
287 |
287 |
$0.00 |
| D0601 |
|
133 |
133 |
$0.00 |