| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,632 |
930 |
$260K |
| D1351 |
Sealant - per tooth |
5,038 |
1,257 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,571 |
3,101 |
$82K |
| D1120 |
Prophylaxis - child |
2,151 |
2,137 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,539 |
2,512 |
$71K |
| D0145 |
Oral evaluation for a patient under three years of age |
405 |
405 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,240 |
3,210 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,258 |
1,246 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,334 |
3,280 |
$40K |
| D1110 |
Prophylaxis - adult |
710 |
699 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
897 |
807 |
$24K |
| D0272 |
Bitewings - two radiographic images |
947 |
940 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
372 |
$13K |
| D0602 |
|
2,944 |
2,915 |
$0.00 |
| D0603 |
|
482 |
479 |
$0.00 |
| D0601 |
|
208 |
208 |
$0.00 |