| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,373 |
909 |
$226K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,215 |
793 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,452 |
1,416 |
$49K |
| D1351 |
Sealant - per tooth |
1,819 |
543 |
$47K |
| D1120 |
Prophylaxis - child |
1,278 |
1,247 |
$44K |
| D1110 |
Prophylaxis - adult |
765 |
746 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,061 |
2,006 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,058 |
1,032 |
$23K |
| D0274 |
Bitewings - four radiographic images |
676 |
657 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,757 |
1,718 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,737 |
1,678 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
533 |
524 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
108 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
50 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
26 |
$6K |
| D0330 |
Panoramic radiographic image |
132 |
117 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
65 |
$2K |
| D0603 |
|
2,363 |
2,296 |
$0.00 |