| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,433 |
818 |
$238K |
| D0145 |
Oral evaluation for a patient under three years of age |
330 |
322 |
$45K |
| D1120 |
Prophylaxis - child |
1,015 |
995 |
$36K |
| D1351 |
Sealant - per tooth |
1,274 |
297 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,261 |
1,110 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,872 |
1,583 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,002 |
985 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
363 |
184 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,570 |
1,542 |
$22K |
| D1110 |
Prophylaxis - adult |
311 |
305 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,696 |
1,638 |
$15K |
| D0274 |
Bitewings - four radiographic images |
521 |
511 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
296 |
$10K |
| D0272 |
Bitewings - two radiographic images |
342 |
338 |
$7K |
| D0330 |
Panoramic radiographic image |
219 |
210 |
$5K |
| D0603 |
|
2,258 |
2,220 |
$0.00 |