| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
8,726 |
2,572 |
$93K |
| D0145 |
Oral evaluation for a patient under three years of age |
656 |
647 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
967 |
475 |
$85K |
| D1351 |
Sealant - per tooth |
3,029 |
683 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,562 |
2,538 |
$72K |
| D1120 |
Prophylaxis - child |
1,906 |
1,889 |
$67K |
| D1110 |
Prophylaxis - adult |
1,043 |
1,032 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
742 |
359 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,703 |
2,675 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,551 |
1,540 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,104 |
3,055 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
457 |
451 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
578 |
521 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
65 |
$9K |
| D0330 |
Panoramic radiographic image |
139 |
136 |
$5K |
| D1206 |
Topical application of fluoride varnish |
360 |
360 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
12 |
$692.76 |
| D0603 |
|
4,338 |
4,303 |
$26.21 |