| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,466 |
606 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
2,583 |
2,426 |
$66K |
| D1110 |
Prophylaxis - adult |
1,300 |
1,230 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,537 |
1,447 |
$43K |
| D1120 |
Prophylaxis - child |
1,243 |
1,188 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
518 |
255 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,834 |
1,318 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,129 |
995 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
195 |
193 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,568 |
1,506 |
$21K |
| D1351 |
Sealant - per tooth |
776 |
144 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,568 |
1,462 |
$17K |
| D0272 |
Bitewings - two radiographic images |
803 |
764 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,196 |
1,121 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
464 |
422 |
$14K |
| D0350 |
|
806 |
774 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
101 |
$6K |
| D0330 |
Panoramic radiographic image |
191 |
179 |
$4K |
| D0603 |
|
4,118 |
3,912 |
$1K |
| D1330 |
|
130 |
126 |
$940.81 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
29 |
$667.38 |