| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,814 |
1,195 |
$374K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,301 |
1,284 |
$181K |
| D1351 |
Sealant - per tooth |
5,571 |
1,050 |
$143K |
| D1120 |
Prophylaxis - child |
2,822 |
2,778 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,353 |
3,299 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,202 |
4,292 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,387 |
4,319 |
$63K |
| D1110 |
Prophylaxis - adult |
995 |
976 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
4,686 |
4,570 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,264 |
1,240 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,054 |
966 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
330 |
180 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
690 |
668 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,156 |
1,139 |
$23K |
| D0350 |
|
1,605 |
1,556 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
63 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
138 |
$9K |
| D0330 |
Panoramic radiographic image |
636 |
618 |
$8K |
| D1330 |
|
85 |
85 |
$12.25 |
| D0603 |
|
5,798 |
5,704 |
$0.00 |
| D0602 |
|
178 |
174 |
$0.00 |
| D0601 |
|
32 |
32 |
$0.00 |