| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
712 |
185 |
$71K |
| D0145 |
Oral evaluation for a patient under three years of age |
260 |
256 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
432 |
425 |
$27K |
| D1120 |
Prophylaxis - child |
747 |
735 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,055 |
741 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
746 |
732 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,336 |
1,314 |
$19K |
| D1110 |
Prophylaxis - adult |
300 |
294 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
369 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
880 |
847 |
$10K |
| D0272 |
Bitewings - two radiographic images |
376 |
374 |
$9K |
| D1351 |
Sealant - per tooth |
297 |
63 |
$8K |
| D2335 |
|
21 |
13 |
$3K |
| D0274 |
Bitewings - four radiographic images |
91 |
89 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
105 |
103 |
$3K |
| D0603 |
|
2,019 |
1,971 |
$0.00 |