| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,831 |
906 |
$157K |
| D1110 |
Prophylaxis - adult |
3,120 |
2,982 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
5,598 |
5,308 |
$147K |
| D1120 |
Prophylaxis - child |
3,608 |
3,447 |
$122K |
| D1351 |
Sealant - per tooth |
4,572 |
789 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,440 |
3,253 |
$103K |
| D0145 |
Oral evaluation for a patient under three years of age |
780 |
751 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,653 |
6,366 |
$90K |
| D0330 |
Panoramic radiographic image |
1,166 |
1,077 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,538 |
1,236 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,327 |
1,273 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
309 |
199 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
668 |
589 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
661 |
568 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
387 |
358 |
$6K |
| D9986 |
|
219 |
204 |
$0.00 |
| D0601 |
|
973 |
951 |
$0.00 |
| D0603 |
|
4,267 |
4,154 |
$0.00 |
| D0602 |
|
1,898 |
1,839 |
$0.00 |