| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,997 |
1,158 |
$491K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,870 |
562 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,628 |
1,816 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,874 |
1,846 |
$59K |
| D2330 |
|
707 |
306 |
$53K |
| D1120 |
Prophylaxis - child |
1,221 |
1,197 |
$43K |
| D1110 |
Prophylaxis - adult |
657 |
650 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,114 |
1,098 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,871 |
1,841 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,843 |
1,814 |
$23K |
| D1351 |
Sealant - per tooth |
730 |
165 |
$19K |
| D0272 |
Bitewings - two radiographic images |
796 |
792 |
$18K |
| D0274 |
Bitewings - four radiographic images |
413 |
406 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
124 |
120 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
123 |
123 |
$4K |
| D0603 |
|
2,063 |
1,967 |
$0.00 |