| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,271 |
1,792 |
$526K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,551 |
1,011 |
$192K |
| D1351 |
Sealant - per tooth |
3,466 |
1,142 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,376 |
1,337 |
$92K |
| D1120 |
Prophylaxis - child |
2,321 |
2,269 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,194 |
2,134 |
$72K |
| D0145 |
Oral evaluation for a patient under three years of age |
442 |
439 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,542 |
1,964 |
$61K |
| D1110 |
Prophylaxis - adult |
1,051 |
1,026 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,031 |
1,982 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,480 |
3,402 |
$50K |
| D0350 |
|
2,120 |
2,053 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,239 |
1,214 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,073 |
2,016 |
$25K |
| D0274 |
Bitewings - four radiographic images |
695 |
685 |
$23K |
| D0272 |
Bitewings - two radiographic images |
584 |
571 |
$13K |
| D2330 |
|
48 |
31 |
$4K |
| D9248 |
|
13 |
13 |
$2K |
| D0170 |
|
29 |
29 |
$314.26 |
| D0603 |
|
4,060 |
3,928 |
$0.00 |