| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,527 |
570 |
$121K |
| D0145 |
Oral evaluation for a patient under three years of age |
815 |
782 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,640 |
2,780 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,031 |
455 |
$67K |
| D1120 |
Prophylaxis - child |
1,761 |
1,693 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,010 |
1,937 |
$54K |
| D1110 |
Prophylaxis - adult |
1,023 |
989 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,442 |
1,385 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,820 |
2,714 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,081 |
2,934 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
866 |
811 |
$27K |
| D1351 |
Sealant - per tooth |
1,149 |
250 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
65 |
$13K |
| D0272 |
Bitewings - two radiographic images |
297 |
291 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
69 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
120 |
110 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$702.02 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$242.16 |
| D0603 |
|
1,595 |
1,544 |
$10.08 |
| D0602 |
|
537 |
522 |
$9.00 |
| D0601 |
|
1,547 |
1,476 |
$0.01 |
| D0431 |
|
123 |
114 |
$0.00 |