| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,353 |
1,273 |
$308K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,307 |
1,282 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
6,059 |
5,864 |
$165K |
| D1351 |
Sealant - per tooth |
6,170 |
1,746 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,942 |
5,118 |
$158K |
| D1120 |
Prophylaxis - child |
4,136 |
4,008 |
$142K |
| D1110 |
Prophylaxis - adult |
2,324 |
2,256 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,289 |
678 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,449 |
6,252 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,382 |
1,335 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,169 |
2,112 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,469 |
5,291 |
$65K |
| D0272 |
Bitewings - two radiographic images |
1,554 |
1,503 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
594 |
568 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
554 |
511 |
$13K |
| D0350 |
|
758 |
717 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
122 |
$2K |
| D9248 |
|
13 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
26 |
$1K |
| D1330 |
|
54 |
53 |
$626.50 |
| D0603 |
|
8,060 |
7,864 |
$0.00 |