| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,263 |
494 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,582 |
3,022 |
$111K |
| D1351 |
Sealant - per tooth |
3,761 |
660 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,973 |
2,881 |
$80K |
| D1120 |
Prophylaxis - child |
2,210 |
2,143 |
$75K |
| D1110 |
Prophylaxis - adult |
798 |
763 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,293 |
3,171 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
260 |
247 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,811 |
1,728 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,536 |
1,512 |
$21K |
| D0274 |
Bitewings - four radiographic images |
578 |
534 |
$17K |
| D0272 |
Bitewings - two radiographic images |
472 |
465 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
75 |
29 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
49 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
163 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
217 |
199 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
27 |
$4K |
| D0602 |
|
376 |
346 |
$0.01 |
| D0431 |
|
69 |
59 |
$0.00 |
| D0603 |
|
2,978 |
2,903 |
$0.00 |
| D0601 |
|
329 |
314 |
$0.00 |