| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,817 |
1,191 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
7,410 |
7,240 |
$203K |
| D1110 |
Prophylaxis - adult |
3,586 |
3,486 |
$180K |
| D1120 |
Prophylaxis - child |
4,692 |
4,571 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,936 |
7,632 |
$117K |
| D0145 |
Oral evaluation for a patient under three years of age |
846 |
814 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,332 |
3,255 |
$106K |
| D1206 |
Topical application of fluoride varnish |
7,191 |
7,007 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
8,266 |
8,045 |
$97K |
| D0272 |
Bitewings - two radiographic images |
3,042 |
2,951 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
415 |
220 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
623 |
$21K |
| D1351 |
Sealant - per tooth |
773 |
143 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
793 |
771 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
225 |
208 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
55 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
39 |
$398.82 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$220.05 |
| D0603 |
|
9,919 |
9,692 |
$0.00 |