| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
684 |
228 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
990 |
967 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,313 |
1,040 |
$24K |
| D1120 |
Prophylaxis - child |
695 |
678 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,472 |
1,437 |
$21K |
| D1110 |
Prophylaxis - adult |
339 |
334 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,319 |
1,284 |
$15K |
| D1351 |
Sealant - per tooth |
577 |
119 |
$14K |
| D0274 |
Bitewings - four radiographic images |
414 |
410 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
92 |
91 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
40 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
201 |
195 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
51 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
57 |
$2K |
| D0272 |
Bitewings - two radiographic images |
71 |
70 |
$2K |
| D0603 |
|
1,273 |
1,247 |
$0.00 |
| D0602 |
|
29 |
29 |
$0.00 |
| D0601 |
|
415 |
411 |
$0.00 |