| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,613 |
1,757 |
$357K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,974 |
1,959 |
$275K |
| D1351 |
Sealant - per tooth |
5,530 |
1,476 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
4,328 |
4,289 |
$122K |
| D1120 |
Prophylaxis - child |
3,091 |
3,070 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,200 |
701 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,142 |
4,039 |
$89K |
| D1110 |
Prophylaxis - adult |
1,634 |
1,612 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,929 |
4,886 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,429 |
2,265 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,747 |
1,719 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,239 |
4,189 |
$52K |
| D0330 |
Panoramic radiographic image |
689 |
679 |
$42K |
| D0272 |
Bitewings - two radiographic images |
852 |
850 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
449 |
441 |
$15K |
| D0603 |
|
6,379 |
6,333 |
$0.00 |
| D0602 |
|
706 |
704 |
$0.00 |