| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,836 |
1,702 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,862 |
1,471 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
4,258 |
4,233 |
$121K |
| D1110 |
Prophylaxis - adult |
2,010 |
1,999 |
$108K |
| D1120 |
Prophylaxis - child |
2,656 |
2,635 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,435 |
4,198 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,668 |
4,634 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,433 |
4,373 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,562 |
1,552 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,711 |
1,696 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
243 |
243 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
223 |
221 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
310 |
288 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
166 |
$6K |
| D1351 |
Sealant - per tooth |
122 |
35 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
92 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D7111 |
|
82 |
56 |
$929.07 |
| D0601 |
|
1,209 |
1,201 |
$0.00 |
| D0603 |
|
3,344 |
3,322 |
$0.00 |
| D0602 |
|
441 |
439 |
$0.00 |