| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,980 |
2,055 |
$479K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,242 |
1,558 |
$246K |
| D1351 |
Sealant - per tooth |
5,614 |
1,558 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,733 |
5,795 |
$107K |
| D1120 |
Prophylaxis - child |
2,868 |
2,828 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,301 |
3,269 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,573 |
2,525 |
$86K |
| D1110 |
Prophylaxis - adult |
1,775 |
1,756 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,092 |
2,975 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,583 |
2,553 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,739 |
4,673 |
$65K |
| D0330 |
Panoramic radiographic image |
2,070 |
2,032 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
6,183 |
6,060 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,360 |
2,323 |
$44K |
| D0145 |
Oral evaluation for a patient under three years of age |
305 |
303 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
341 |
$23K |
| D1330 |
|
1,014 |
994 |
$10K |
| D0350 |
|
673 |
659 |
$7K |
| D0250 |
|
505 |
497 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
29 |
$5K |
| D0603 |
|
6,921 |
6,829 |
$0.00 |