| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,241 |
373 |
$119K |
| D1351 |
Sealant - per tooth |
3,068 |
572 |
$81K |
| D1120 |
Prophylaxis - child |
998 |
976 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
245 |
240 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,023 |
1,001 |
$29K |
| D1110 |
Prophylaxis - adult |
475 |
467 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,613 |
1,574 |
$23K |
| D0274 |
Bitewings - four radiographic images |
657 |
642 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,834 |
1,470 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,639 |
1,588 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
68 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
450 |
436 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
372 |
343 |
$10K |
| D0272 |
Bitewings - two radiographic images |
371 |
365 |
$8K |
| D0603 |
|
2,088 |
2,053 |
$9.00 |