| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,541 |
4,926 |
$927K |
| D0120 |
Periodic oral evaluation - established patient |
14,353 |
14,205 |
$404K |
| D1120 |
Prophylaxis - child |
10,843 |
10,745 |
$384K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,921 |
2,760 |
$379K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,391 |
12,554 |
$337K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,705 |
1,682 |
$234K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,268 |
15,108 |
$218K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,109 |
7,945 |
$211K |
| D1351 |
Sealant - per tooth |
6,505 |
1,969 |
$173K |
| D0220 |
Intraoral - periapical first radiographic image |
13,325 |
13,165 |
$162K |
| D1110 |
Prophylaxis - adult |
2,634 |
2,611 |
$141K |
| D0272 |
Bitewings - two radiographic images |
3,836 |
3,807 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,135 |
1,130 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,604 |
1,586 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
78 |
$11K |
| D0350 |
|
257 |
245 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
50 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
37 |
$676.08 |
| D0603 |
|
19,093 |
18,918 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |