| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,098 |
745 |
$309K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,188 |
1,170 |
$162K |
| D1351 |
Sealant - per tooth |
5,176 |
827 |
$136K |
| D1120 |
Prophylaxis - child |
2,784 |
2,753 |
$99K |
| D1110 |
Prophylaxis - adult |
1,871 |
1,845 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,385 |
3,348 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,594 |
2,564 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,655 |
4,596 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,930 |
3,256 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,503 |
3,458 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,244 |
1,219 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,095 |
968 |
$29K |
| D0330 |
Panoramic radiographic image |
907 |
899 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,118 |
1,115 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
193 |
190 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
92 |
$2K |
| D0603 |
|
4,509 |
4,437 |
$867.04 |
| D0601 |
|
1,306 |
1,288 |
$0.00 |