| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,182 |
791 |
$154K |
| D0145 |
Oral evaluation for a patient under three years of age |
654 |
652 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,065 |
482 |
$57K |
| D1351 |
Sealant - per tooth |
2,738 |
630 |
$54K |
| D1120 |
Prophylaxis - child |
1,446 |
1,425 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,528 |
1,513 |
$34K |
| D1110 |
Prophylaxis - adult |
817 |
809 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,314 |
2,283 |
$24K |
| D0274 |
Bitewings - four radiographic images |
978 |
968 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
713 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,346 |
1,910 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,091 |
2,055 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
342 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
688 |
641 |
$13K |
| D0272 |
Bitewings - two radiographic images |
554 |
550 |
$8K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$871.40 |
| D0603 |
|
2,329 |
2,315 |
$0.00 |
| D0601 |
|
465 |
462 |
$0.00 |
| D0602 |
|
42 |
40 |
$0.00 |