| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,157 |
510 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,349 |
3,289 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
638 |
634 |
$88K |
| D1120 |
Prophylaxis - child |
2,298 |
2,268 |
$78K |
| D1110 |
Prophylaxis - adult |
1,340 |
1,317 |
$66K |
| D1351 |
Sealant - per tooth |
2,462 |
383 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,003 |
2,961 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,599 |
3,545 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,310 |
1,289 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,237 |
3,162 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
271 |
$9K |
| D0272 |
Bitewings - two radiographic images |
368 |
359 |
$8K |
| D0330 |
Panoramic radiographic image |
40 |
38 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
32 |
$921.74 |
| D0602 |
|
1,467 |
1,450 |
$0.00 |
| D0601 |
|
1,684 |
1,666 |
$0.00 |
| D0603 |
|
1,248 |
1,237 |
$0.00 |