| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,977 |
4,145 |
$701K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,483 |
3,420 |
$477K |
| D1351 |
Sealant - per tooth |
15,544 |
3,873 |
$383K |
| D0120 |
Periodic oral evaluation - established patient |
13,909 |
13,291 |
$375K |
| D1110 |
Prophylaxis - adult |
7,122 |
6,843 |
$363K |
| D1120 |
Prophylaxis - child |
10,176 |
9,709 |
$347K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,700 |
2,575 |
$306K |
| D0274 |
Bitewings - four radiographic images |
9,661 |
9,221 |
$281K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,938 |
16,273 |
$233K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,408 |
12,036 |
$182K |
| D0220 |
Intraoral - periapical first radiographic image |
13,808 |
13,089 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,695 |
3,518 |
$118K |
| D0272 |
Bitewings - two radiographic images |
5,683 |
5,428 |
$114K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,599 |
3,102 |
$86K |
| D0330 |
Panoramic radiographic image |
3,093 |
2,980 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
399 |
282 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
503 |
501 |
$33K |
| D1330 |
|
8,584 |
7,721 |
$32K |
| D0350 |
|
3,259 |
1,255 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
139 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
26 |
$2K |
| D0170 |
|
103 |
101 |
$2K |
| D9215 |
|
6,002 |
5,325 |
$194.78 |
| D9910 |
|
220 |
167 |
$119.40 |
| D0603 |
|
20,520 |
19,637 |
$0.01 |
| D1999 |
|
18,186 |
16,326 |
$0.00 |
| D0602 |
|
488 |
482 |
$0.00 |
| D0601 |
|
256 |
254 |
$0.00 |