| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,749 |
737 |
$166K |
| D1351 |
Sealant - per tooth |
5,122 |
1,214 |
$132K |
| D0145 |
Oral evaluation for a patient under three years of age |
901 |
888 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,539 |
698 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,580 |
3,520 |
$101K |
| D1120 |
Prophylaxis - child |
2,732 |
2,688 |
$97K |
| D1110 |
Prophylaxis - adult |
1,597 |
1,549 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,208 |
1,167 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,351 |
4,251 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,814 |
1,786 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,371 |
3,288 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,083 |
3,023 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,206 |
1,137 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,328 |
1,311 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
628 |
605 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
57 |
$1K |
| D0603 |
|
5,376 |
5,269 |
$0.00 |