| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
940 |
522 |
$84K |
| D1120 |
Prophylaxis - child |
2,049 |
2,028 |
$73K |
| D0145 |
Oral evaluation for a patient under three years of age |
495 |
490 |
$69K |
| D1351 |
Sealant - per tooth |
2,564 |
591 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,332 |
2,317 |
$65K |
| D1110 |
Prophylaxis - adult |
1,073 |
1,069 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,046 |
3,024 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,252 |
1,244 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
494 |
492 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
444 |
278 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,579 |
2,531 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,531 |
2,370 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,044 |
1,036 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
665 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
230 |
194 |
$6K |
| D1330 |
|
141 |
141 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$244.14 |
| D0602 |
|
804 |
799 |
$0.00 |
| D0603 |
|
2,695 |
2,684 |
$0.00 |
| D0601 |
|
44 |
44 |
$0.00 |
| D9986 |
|
90 |
72 |
$0.00 |
| D1999 |
|
530 |
463 |
$0.00 |