| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
856 |
500 |
$90K |
| D1120 |
Prophylaxis - child |
4,258 |
3,187 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,966 |
1,876 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,607 |
2,374 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
822 |
751 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
331 |
220 |
$27K |
| D0330 |
Panoramic radiographic image |
687 |
685 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
328 |
325 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,478 |
1,245 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,721 |
887 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
261 |
261 |
$17K |
| D1351 |
Sealant - per tooth |
526 |
132 |
$14K |
| D0274 |
Bitewings - four radiographic images |
560 |
559 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,081 |
737 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
660 |
654 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
516 |
466 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
97 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$3K |
| D0603 |
|
1,914 |
1,240 |
$0.00 |