| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,793 |
1,853 |
$362K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,499 |
1,440 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
6,798 |
6,694 |
$182K |
| D1110 |
Prophylaxis - adult |
3,184 |
3,118 |
$159K |
| D1120 |
Prophylaxis - child |
4,611 |
4,529 |
$156K |
| D0274 |
Bitewings - four radiographic images |
3,461 |
3,396 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
7,360 |
7,195 |
$84K |
| D1351 |
Sealant - per tooth |
3,089 |
537 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,344 |
6,633 |
$77K |
| D1206 |
Topical application of fluoride varnish |
5,464 |
5,346 |
$74K |
| D7240 |
Removal of impacted tooth - completely bony |
173 |
58 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,869 |
1,825 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,916 |
1,900 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
719 |
697 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
365 |
345 |
$10K |
| D9243 |
|
216 |
82 |
$7K |
| D9239 |
|
88 |
82 |
$4K |
| D0330 |
Panoramic radiographic image |
95 |
93 |
$3K |
| D9612 |
|
74 |
68 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
54 |
$957.78 |
| D0601 |
|
5,249 |
5,114 |
$0.00 |
| D0603 |
|
2,956 |
2,910 |
$0.00 |
| D0602 |
|
956 |
951 |
$0.00 |