| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,388 |
896 |
$180K |
| D1351 |
Sealant - per tooth |
6,310 |
1,139 |
$132K |
| D0145 |
Oral evaluation for a patient under three years of age |
947 |
932 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,982 |
3,888 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,294 |
3,245 |
$75K |
| D1120 |
Prophylaxis - child |
2,509 |
2,460 |
$67K |
| D1110 |
Prophylaxis - adult |
1,396 |
1,371 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,883 |
1,844 |
$48K |
| D1206 |
Topical application of fluoride varnish |
3,864 |
3,796 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,357 |
4,204 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
644 |
601 |
$16K |
| D0272 |
Bitewings - two radiographic images |
954 |
932 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
302 |
274 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
78 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$764.93 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$579.69 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$110.25 |
| D0603 |
|
3,184 |
3,140 |
$18.28 |
| D0601 |
|
1,396 |
1,377 |
$0.04 |
| D0602 |
|
189 |
189 |
$0.00 |