| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,198 |
1,320 |
$315K |
| D1351 |
Sealant - per tooth |
10,136 |
2,218 |
$260K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,461 |
1,294 |
$182K |
| D1110 |
Prophylaxis - adult |
2,843 |
2,798 |
$145K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,342 |
6,251 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,069 |
4,002 |
$112K |
| D1120 |
Prophylaxis - child |
3,129 |
3,090 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,517 |
3,447 |
$99K |
| D0145 |
Oral evaluation for a patient under three years of age |
675 |
665 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,668 |
2,590 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,022 |
5,942 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
6,515 |
6,348 |
$61K |
| D0330 |
Panoramic radiographic image |
1,815 |
1,768 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,931 |
1,914 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
360 |
$23K |
| D9248 |
|
88 |
83 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
28 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
134 |
128 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
98 |
$2K |
| D2950 |
|
25 |
12 |
$2K |
| D0273 |
|
85 |
83 |
$2K |
| D7111 |
|
25 |
13 |
$240.87 |
| D0603 |
|
7,677 |
7,511 |
$0.00 |