| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,663 |
3,109 |
$1.10M |
| D2331 |
|
3,686 |
1,587 |
$360K |
| D0210 |
Intraoral - complete series of radiographic images |
3,327 |
3,316 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,598 |
1,281 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,146 |
4,129 |
$145K |
| D1120 |
Prophylaxis - child |
2,789 |
2,781 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,340 |
3,323 |
$90K |
| D1110 |
Prophylaxis - adult |
1,428 |
1,420 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,184 |
4,168 |
$61K |
| D0145 |
Oral evaluation for a patient under three years of age |
351 |
349 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,052 |
887 |
$45K |
| D1351 |
Sealant - per tooth |
716 |
173 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
906 |
889 |
$11K |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
28 |
$807.80 |
| D0603 |
|
4,637 |
4,622 |
$0.00 |