| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,228 |
1,100 |
$197K |
| D1110 |
Prophylaxis - adult |
2,519 |
2,478 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,638 |
4,579 |
$130K |
| D1351 |
Sealant - per tooth |
4,889 |
856 |
$117K |
| D0274 |
Bitewings - four radiographic images |
2,797 |
2,744 |
$91K |
| D1120 |
Prophylaxis - child |
2,207 |
2,181 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,099 |
567 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,973 |
4,905 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,682 |
4,586 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
5,017 |
4,923 |
$60K |
| D0272 |
Bitewings - two radiographic images |
1,068 |
1,054 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
162 |
162 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
215 |
211 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
95 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
114 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
98 |
$2K |
| D1330 |
|
115 |
114 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$457.89 |
| D9986 |
|
20 |
20 |
$0.00 |
| D0603 |
|
5,592 |
5,474 |
$0.00 |
| D0602 |
|
240 |
230 |
$0.00 |
| D0601 |
|
32 |
32 |
$0.00 |