| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,290 |
580 |
$124K |
| D1110 |
Prophylaxis - adult |
1,810 |
1,737 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,263 |
2,187 |
$61K |
| D1120 |
Prophylaxis - child |
1,217 |
1,172 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,744 |
2,643 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,446 |
1,399 |
$34K |
| D1351 |
Sealant - per tooth |
1,021 |
180 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
775 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,596 |
2,483 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,421 |
2,283 |
$19K |
| D0330 |
Panoramic radiographic image |
682 |
658 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
125 |
$16K |
| D0272 |
Bitewings - two radiographic images |
607 |
591 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
72 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
26 |
$805.68 |
| D0603 |
|
3,285 |
3,162 |
$520.78 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$223.48 |
| D0602 |
|
141 |
138 |
$9.01 |
| D1999 |
|
381 |
325 |
$0.00 |
| D9986 |
|
13 |
13 |
$0.00 |