| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,295 |
2,713 |
$697K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,924 |
1,914 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,359 |
1,592 |
$256K |
| D1120 |
Prophylaxis - child |
4,311 |
4,262 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,318 |
4,581 |
$112K |
| D1351 |
Sealant - per tooth |
4,239 |
1,118 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,841 |
3,807 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,506 |
1,486 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,749 |
3,574 |
$97K |
| D1110 |
Prophylaxis - adult |
1,808 |
1,786 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,306 |
6,234 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,321 |
2,278 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,042 |
4,953 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,397 |
1,383 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,558 |
1,541 |
$35K |
| D0350 |
|
1,592 |
1,569 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
54 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
288 |
$5K |
| D0603 |
|
8,485 |
8,422 |
$0.00 |