| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,079 |
334 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
370 |
354 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
168 |
164 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
574 |
548 |
$18K |
| D1120 |
Prophylaxis - child |
446 |
428 |
$15K |
| D1351 |
Sealant - per tooth |
415 |
102 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
413 |
375 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
626 |
600 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
43 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
603 |
180 |
$6K |
| D1110 |
Prophylaxis - adult |
73 |
67 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
209 |
200 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
68 |
65 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$303.94 |
| D0603 |
|
956 |
920 |
$0.00 |