| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,410 |
393 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
2,462 |
2,421 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
885 |
324 |
$67K |
| D1120 |
Prophylaxis - child |
1,509 |
1,479 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,680 |
2,472 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,800 |
1,768 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,711 |
2,663 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,698 |
2,640 |
$33K |
| D1110 |
Prophylaxis - adult |
564 |
554 |
$30K |
| D1351 |
Sealant - per tooth |
416 |
85 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$298.21 |
| D0602 |
|
2,780 |
2,727 |
$18.09 |
| D0603 |
|
104 |
103 |
$0.00 |