| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,856 |
2,359 |
$561K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,600 |
1,388 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
6,253 |
6,139 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,150 |
6,171 |
$174K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,244 |
1,233 |
$172K |
| D1120 |
Prophylaxis - child |
4,246 |
4,172 |
$148K |
| D1110 |
Prophylaxis - adult |
2,467 |
2,428 |
$129K |
| D0274 |
Bitewings - four radiographic images |
3,350 |
3,258 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,917 |
6,797 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,478 |
6,343 |
$78K |
| D1351 |
Sealant - per tooth |
2,528 |
807 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,007 |
1,909 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
595 |
578 |
$39K |
| D0272 |
Bitewings - two radiographic images |
973 |
960 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
600 |
576 |
$20K |
| D0350 |
|
181 |
175 |
$3K |
| D1330 |
|
246 |
245 |
$3K |
| D0603 |
|
5,775 |
5,686 |
$0.00 |
| D0601 |
|
860 |
851 |
$0.00 |
| D0602 |
|
1,536 |
1,505 |
$0.00 |