| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
948 |
329 |
$73K |
| D1351 |
Sealant - per tooth |
2,177 |
426 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
910 |
801 |
$27K |
| D1120 |
Prophylaxis - child |
769 |
673 |
$23K |
| D0274 |
Bitewings - four radiographic images |
575 |
501 |
$16K |
| D2332 |
|
138 |
57 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,110 |
977 |
$14K |
| D1110 |
Prophylaxis - adult |
288 |
258 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,066 |
920 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,022 |
892 |
$10K |
| D0272 |
Bitewings - two radiographic images |
432 |
382 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
35 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
179 |
155 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$640.60 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
22 |
$596.42 |
| D0603 |
|
1,224 |
1,068 |
$0.00 |