| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,205 |
1,618 |
$407K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,722 |
7,161 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
7,036 |
6,926 |
$197K |
| D1120 |
Prophylaxis - child |
4,562 |
4,492 |
$160K |
| D1110 |
Prophylaxis - adult |
2,988 |
2,938 |
$156K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,071 |
1,055 |
$143K |
| D0274 |
Bitewings - four radiographic images |
4,022 |
3,942 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,750 |
7,629 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
7,549 |
7,408 |
$91K |
| D1351 |
Sealant - per tooth |
1,973 |
480 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,888 |
1,770 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
497 |
267 |
$37K |
| D7240 |
Removal of impacted tooth - completely bony |
113 |
38 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,137 |
1,121 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
337 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
120 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
556 |
538 |
$18K |
| D1330 |
|
116 |
116 |
$1K |
| D0170 |
|
40 |
39 |
$578.90 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$507.06 |
| D0330 |
Panoramic radiographic image |
90 |
89 |
$244.11 |
| D0603 |
|
9,029 |
8,906 |
$0.00 |
| D0601 |
|
88 |
87 |
$0.00 |
| D0602 |
|
205 |
201 |
$0.00 |