| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,972 |
2,149 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
8,071 |
8,017 |
$228K |
| D1110 |
Prophylaxis - adult |
3,759 |
3,735 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,840 |
1,603 |
$201K |
| D1120 |
Prophylaxis - child |
4,609 |
4,573 |
$167K |
| D0274 |
Bitewings - four radiographic images |
3,913 |
3,882 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,519 |
8,457 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
8,671 |
8,593 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,656 |
8,574 |
$95K |
| D0272 |
Bitewings - two radiographic images |
3,932 |
3,905 |
$88K |
| D0145 |
Oral evaluation for a patient under three years of age |
639 |
630 |
$88K |
| D1351 |
Sealant - per tooth |
2,731 |
668 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,540 |
1,441 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
67 |
$4K |
| D0330 |
Panoramic radiographic image |
363 |
360 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$544.62 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$455.63 |
| D0603 |
|
9,600 |
9,534 |
$0.00 |