| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,501 |
4,642 |
$1.56M |
| D0210 |
Intraoral - complete series of radiographic images |
4,064 |
4,055 |
$284K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,595 |
1,597 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,163 |
5,145 |
$180K |
| D1351 |
Sealant - per tooth |
4,798 |
1,548 |
$130K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,871 |
4,829 |
$130K |
| D1120 |
Prophylaxis - child |
3,590 |
3,575 |
$129K |
| D1110 |
Prophylaxis - adult |
1,765 |
1,763 |
$94K |
| D0145 |
Oral evaluation for a patient under three years of age |
615 |
612 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,306 |
5,290 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,758 |
1,232 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
337 |
229 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,292 |
1,264 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
47 |
46 |
$1K |
| D0603 |
|
6,073 |
6,050 |
$0.00 |