| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,659 |
863 |
$252K |
| D0145 |
Oral evaluation for a patient under three years of age |
672 |
662 |
$92K |
| D1351 |
Sealant - per tooth |
3,438 |
470 |
$90K |
| D1120 |
Prophylaxis - child |
1,930 |
1,900 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,339 |
2,286 |
$64K |
| D1110 |
Prophylaxis - adult |
1,175 |
1,140 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,732 |
3,007 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,380 |
1,344 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,035 |
2,977 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,522 |
3,354 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
713 |
694 |
$23K |
| D0272 |
Bitewings - two radiographic images |
960 |
947 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
41 |
$7K |
| D1330 |
|
230 |
223 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
66 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
36 |
32 |
$944.69 |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$887.07 |
| D0603 |
|
1,366 |
1,340 |
$54.11 |
| D0601 |
|
2,456 |
2,408 |
$9.03 |