| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,817 |
2,726 |
$769K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,964 |
6,871 |
$276K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,762 |
1,728 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,098 |
1,372 |
$235K |
| D1351 |
Sealant - per tooth |
7,021 |
2,033 |
$188K |
| D1120 |
Prophylaxis - child |
4,787 |
4,703 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
5,982 |
5,865 |
$168K |
| D1110 |
Prophylaxis - adult |
2,190 |
2,144 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,158 |
3,995 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,259 |
7,122 |
$103K |
| D0272 |
Bitewings - two radiographic images |
4,461 |
4,362 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
7,533 |
7,366 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,238 |
1,217 |
$42K |
| D0240 |
|
2,315 |
1,159 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
176 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
37 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
93 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
26 |
$2K |
| D0603 |
|
9,821 |
9,629 |
$0.00 |