| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,165 |
819 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
3,233 |
3,179 |
$90K |
| D1351 |
Sealant - per tooth |
3,388 |
515 |
$87K |
| D1120 |
Prophylaxis - child |
2,256 |
2,235 |
$81K |
| D1110 |
Prophylaxis - adult |
1,373 |
1,349 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,017 |
1,977 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,705 |
3,644 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,342 |
3,484 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,720 |
3,639 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,377 |
1,366 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
690 |
605 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
109 |
109 |
$15K |
| D0330 |
Panoramic radiographic image |
638 |
628 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
225 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
93 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
19 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$225.36 |
| D0603 |
|
3,504 |
2,959 |
$0.00 |
| D0601 |
|
1,225 |
1,187 |
$0.00 |
| D0602 |
|
417 |
378 |
$0.00 |