| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,376 |
579 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
3,032 |
2,967 |
$84K |
| D1351 |
Sealant - per tooth |
2,501 |
628 |
$64K |
| D0145 |
Oral evaluation for a patient under three years of age |
451 |
447 |
$62K |
| D1120 |
Prophylaxis - child |
1,645 |
1,615 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,720 |
3,203 |
$51K |
| D1110 |
Prophylaxis - adult |
969 |
947 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,329 |
3,260 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,411 |
3,315 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,004 |
978 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
287 |
178 |
$22K |
| D0272 |
Bitewings - two radiographic images |
743 |
726 |
$17K |
| D0350 |
|
1,244 |
1,212 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
78 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
55 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
15 |
$319.26 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$246.69 |
| D0601 |
|
188 |
187 |
$0.00 |
| D0603 |
|
4,196 |
4,103 |
$0.00 |
| D0602 |
|
60 |
58 |
$0.00 |