| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,545 |
708 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
4,004 |
3,844 |
$98K |
| D1351 |
Sealant - per tooth |
4,363 |
1,137 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,601 |
841 |
$82K |
| D1206 |
Topical application of fluoride varnish |
4,649 |
4,464 |
$63K |
| D1120 |
Prophylaxis - child |
2,839 |
2,744 |
$61K |
| D1110 |
Prophylaxis - adult |
1,756 |
1,668 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,429 |
4,346 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,824 |
4,613 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,596 |
1,511 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,393 |
2,311 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
636 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
410 |
386 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
53 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
13 |
$481.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$381.00 |