| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,496 |
861 |
$240K |
| D1110 |
Prophylaxis - adult |
1,531 |
1,494 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,697 |
2,647 |
$75K |
| D1120 |
Prophylaxis - child |
1,541 |
1,517 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,636 |
1,597 |
$49K |
| D1351 |
Sealant - per tooth |
1,873 |
401 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
317 |
314 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,074 |
3,023 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,422 |
2,822 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,047 |
2,969 |
$36K |
| D0350 |
|
1,708 |
1,678 |
$22K |
| D0272 |
Bitewings - two radiographic images |
855 |
841 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
205 |
89 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
386 |
$14K |
| D0330 |
Panoramic radiographic image |
185 |
179 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
69 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$1K |
| D0603 |
|
3,151 |
3,116 |
$0.00 |
| D0602 |
|
562 |
555 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |