| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,413 |
950 |
$344K |
| D1351 |
Sealant - per tooth |
7,845 |
1,562 |
$212K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,139 |
1,134 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,705 |
603 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
4,570 |
4,562 |
$131K |
| D1110 |
Prophylaxis - adult |
2,117 |
2,111 |
$115K |
| D1120 |
Prophylaxis - child |
3,084 |
3,078 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,788 |
2,781 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,185 |
5,173 |
$75K |
| D0330 |
Panoramic radiographic image |
1,201 |
1,197 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,530 |
1,526 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
566 |
562 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
110 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
138 |
123 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D2330 |
|
23 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
107 |
107 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
30 |
$317.45 |
| D0603 |
|
6,008 |
5,995 |
$0.05 |
| D0602 |
|
317 |
316 |
$0.03 |