| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,252 |
1,059 |
$202K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,248 |
1,220 |
$164K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,948 |
4,584 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
4,585 |
4,475 |
$126K |
| D1120 |
Prophylaxis - child |
3,192 |
3,138 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,181 |
2,113 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,737 |
4,640 |
$66K |
| D1110 |
Prophylaxis - adult |
1,262 |
1,230 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,018 |
4,837 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,750 |
1,648 |
$43K |
| D1351 |
Sealant - per tooth |
1,494 |
476 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
311 |
$35K |
| D0272 |
Bitewings - two radiographic images |
758 |
738 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
150 |
$9K |
| D1330 |
|
1,076 |
1,048 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
240 |
$7K |
| D1206 |
Topical application of fluoride varnish |
164 |
160 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$905.96 |
| D0603 |
|
6,812 |
6,634 |
$0.00 |