| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
633 |
230 |
$57K |
| D1351 |
Sealant - per tooth |
1,991 |
368 |
$49K |
| D1110 |
Prophylaxis - adult |
638 |
618 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,153 |
1,097 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,277 |
1,163 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
326 |
175 |
$23K |
| D1120 |
Prophylaxis - child |
621 |
597 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,422 |
1,371 |
$20K |
| D0274 |
Bitewings - four radiographic images |
555 |
537 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,315 |
1,263 |
$15K |
| D0272 |
Bitewings - two radiographic images |
385 |
372 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
217 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
153 |
139 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
30 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
38 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
190 |
173 |
$5K |
| D0330 |
Panoramic radiographic image |
201 |
190 |
$4K |
| D0350 |
|
155 |
145 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
35 |
$799.25 |
| D0240 |
|
21 |
18 |
$134.80 |
| D0603 |
|
1,200 |
1,164 |
$0.00 |
| D0602 |
|
498 |
490 |
$0.00 |