| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
392 |
260 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
186 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
480 |
477 |
$7K |
| D1120 |
Prophylaxis - child |
382 |
379 |
$7K |
| D1351 |
Sealant - per tooth |
503 |
96 |
$7K |
| D1110 |
Prophylaxis - adult |
244 |
241 |
$7K |
| D0274 |
Bitewings - four radiographic images |
300 |
296 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
62 |
62 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
491 |
485 |
$3K |
| D0272 |
Bitewings - two radiographic images |
243 |
242 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
377 |
373 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
460 |
440 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
144 |
$2K |
| D1206 |
Topical application of fluoride varnish |
239 |
237 |
$2K |
| D0330 |
Panoramic radiographic image |
122 |
122 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
82 |
$1K |
| D0602 |
|
12 |
12 |
$0.00 |
| D0603 |
|
654 |
648 |
$0.00 |
| D0601 |
|
30 |
30 |
$0.00 |