| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,690 |
764 |
$154K |
| D0145 |
Oral evaluation for a patient under three years of age |
776 |
755 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,675 |
3,537 |
$97K |
| D1110 |
Prophylaxis - adult |
1,857 |
1,776 |
$90K |
| D1120 |
Prophylaxis - child |
2,519 |
2,436 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,490 |
3,732 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,246 |
2,142 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,348 |
4,194 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,189 |
3,956 |
$47K |
| D1351 |
Sealant - per tooth |
1,623 |
302 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,195 |
1,092 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
395 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
617 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
119 |
$13K |
| D0272 |
Bitewings - two radiographic images |
309 |
304 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
17 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$206.58 |
| D0602 |
|
2,117 |
2,055 |
$0.00 |
| D0601 |
|
1,247 |
1,213 |
$0.00 |
| D0603 |
|
1,885 |
1,813 |
$0.00 |