| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,205 |
620 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,894 |
3,198 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,909 |
2,862 |
$80K |
| D1120 |
Prophylaxis - child |
1,923 |
1,877 |
$66K |
| D1110 |
Prophylaxis - adult |
1,076 |
1,069 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,817 |
1,775 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
302 |
299 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,024 |
2,964 |
$42K |
| D1351 |
Sealant - per tooth |
1,470 |
374 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,370 |
3,280 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
458 |
289 |
$33K |
| D0330 |
Panoramic radiographic image |
403 |
392 |
$9K |
| D0272 |
Bitewings - two radiographic images |
378 |
372 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
81 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
158 |
132 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
103 |
95 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$448.84 |
| D1999 |
|
130 |
113 |
$0.00 |
| D0603 |
|
2,187 |
2,159 |
$0.00 |
| D0601 |
|
393 |
392 |
$0.00 |
| D0602 |
|
854 |
846 |
$0.00 |