| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,117 |
1,205 |
$208K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,137 |
1,108 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
5,411 |
5,261 |
$145K |
| D1110 |
Prophylaxis - adult |
2,438 |
2,369 |
$123K |
| D1120 |
Prophylaxis - child |
3,140 |
3,060 |
$107K |
| D1351 |
Sealant - per tooth |
3,533 |
661 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,346 |
1,312 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
804 |
575 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,811 |
5,671 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
797 |
505 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,316 |
2,248 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,240 |
1,203 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
455 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
430 |
406 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
260 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
260 |
$3K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
32 |
$2K |
| D0602 |
|
7,260 |
7,047 |
$0.00 |
| D0603 |
|
120 |
119 |
$0.00 |