| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,226 |
952 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
3,366 |
3,198 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
977 |
451 |
$70K |
| D1120 |
Prophylaxis - child |
1,982 |
1,929 |
$69K |
| D1110 |
Prophylaxis - adult |
1,383 |
1,315 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,219 |
2,072 |
$59K |
| D1351 |
Sealant - per tooth |
2,151 |
504 |
$55K |
| D0145 |
Oral evaluation for a patient under three years of age |
387 |
374 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,040 |
3,656 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,654 |
3,521 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,109 |
3,868 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,135 |
1,101 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
117 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
514 |
474 |
$16K |
| D0330 |
Panoramic radiographic image |
264 |
239 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
113 |
104 |
$3K |
| D2330 |
|
22 |
12 |
$2K |
| D7111 |
|
23 |
12 |
$149.11 |
| D0603 |
|
3,444 |
3,331 |
$0.00 |
| D0602 |
|
593 |
579 |
$0.00 |
| D0601 |
|
433 |
423 |
$0.00 |