| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,694 |
797 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
3,515 |
3,383 |
$94K |
| D1120 |
Prophylaxis - child |
2,754 |
2,649 |
$91K |
| D0145 |
Oral evaluation for a patient under three years of age |
722 |
698 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,111 |
3,733 |
$84K |
| D1110 |
Prophylaxis - adult |
1,443 |
1,396 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
782 |
447 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,026 |
3,879 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,172 |
4,004 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,506 |
1,446 |
$48K |
| D1351 |
Sealant - per tooth |
1,675 |
375 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,036 |
1,006 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
681 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
116 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
176 |
157 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
68 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
43 |
$842.44 |
| D1330 |
|
21 |
21 |
$220.03 |
| D0601 |
|
1,313 |
1,247 |
$0.00 |
| D0603 |
|
2,859 |
2,750 |
$0.00 |
| D0602 |
|
939 |
916 |
$0.00 |