| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,540 |
772 |
$141K |
| D1120 |
Prophylaxis - child |
2,461 |
2,394 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,078 |
2,770 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
615 |
592 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,615 |
2,558 |
$72K |
| D1351 |
Sealant - per tooth |
2,620 |
733 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,607 |
3,513 |
$50K |
| D1110 |
Prophylaxis - adult |
753 |
742 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
522 |
312 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,051 |
2,944 |
$35K |
| D0274 |
Bitewings - four radiographic images |
931 |
914 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
368 |
362 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
688 |
653 |
$22K |
| D0272 |
Bitewings - two radiographic images |
656 |
647 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
279 |
236 |
$6K |
| D1330 |
|
81 |
81 |
$698.25 |
| D0603 |
|
4,900 |
4,767 |
$0.00 |