| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,664 |
1,128 |
$341K |
| D1351 |
Sealant - per tooth |
6,931 |
1,277 |
$182K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,052 |
1,050 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
4,665 |
4,601 |
$129K |
| D1120 |
Prophylaxis - child |
3,608 |
3,571 |
$127K |
| D1110 |
Prophylaxis - adult |
2,039 |
2,013 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,591 |
5,534 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,046 |
373 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,976 |
5,885 |
$68K |
| D0272 |
Bitewings - two radiographic images |
3,034 |
3,004 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,117 |
5,556 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,037 |
2,008 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
1,091 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
230 |
230 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
343 |
323 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
290 |
287 |
$6K |
| D0330 |
Panoramic radiographic image |
382 |
376 |
$5K |
| D2332 |
|
37 |
12 |
$3K |
| D0603 |
|
6,632 |
6,569 |
$36.22 |
| D0602 |
|
473 |
468 |
$0.08 |
| D0601 |
|
47 |
47 |
$0.00 |
| D9986 |
|
12 |
12 |
$0.00 |