| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0603 |
|
2,118 |
2,091 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,417 |
949 |
$108K |
| D1110 |
Prophylaxis - adult |
1,843 |
1,794 |
$58K |
| D0602 |
|
757 |
747 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
3,224 |
3,125 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,063 |
1,036 |
$23K |
| D0601 |
|
304 |
299 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
675 |
491 |
$18K |
| D1351 |
Sealant - per tooth |
970 |
342 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
472 |
420 |
$6K |
| D1120 |
Prophylaxis - child |
2,464 |
2,378 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
96 |
96 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
471 |
465 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
39 |
$2K |
| D0330 |
Panoramic radiographic image |
216 |
202 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,297 |
3,918 |
$1K |
| D0274 |
Bitewings - four radiographic images |
1,825 |
1,773 |
$705.42 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
45 |
$646.11 |
| D0999 |
Unspecified diagnostic procedure, by report |
32 |
32 |
$640.00 |
| D0220 |
Intraoral - periapical first radiographic image |
4,232 |
4,101 |
$126.46 |
| D0272 |
Bitewings - two radiographic images |
1,864 |
1,807 |
$121.14 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,756 |
3,629 |
$36.35 |
| D1330 |
|
4,316 |
4,179 |
$6.00 |
| D9986 |
|
42 |
42 |
$0.00 |