| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,069 |
1,406 |
$294K |
| D1351 |
Sealant - per tooth |
7,247 |
1,529 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
5,466 |
5,368 |
$151K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,012 |
1,006 |
$140K |
| D1120 |
Prophylaxis - child |
3,889 |
3,852 |
$138K |
| D1110 |
Prophylaxis - adult |
1,865 |
1,832 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,874 |
2,812 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
6,826 |
6,678 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,767 |
5,995 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,697 |
3,657 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,240 |
2,211 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
266 |
167 |
$21K |
| D0272 |
Bitewings - two radiographic images |
882 |
874 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
526 |
516 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
568 |
538 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
141 |
$3K |
| D0603 |
|
5,688 |
5,635 |
$539.21 |
| D0602 |
|
1,703 |
1,682 |
$0.00 |
| D0601 |
|
18 |
18 |
$0.00 |