| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,358 |
591 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
2,415 |
2,398 |
$69K |
| D1120 |
Prophylaxis - child |
1,481 |
1,470 |
$53K |
| D1110 |
Prophylaxis - adult |
965 |
958 |
$52K |
| D1351 |
Sealant - per tooth |
1,587 |
356 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,469 |
2,451 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,081 |
1,073 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
186 |
184 |
$26K |
| D0272 |
Bitewings - two radiographic images |
980 |
974 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,719 |
1,699 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,693 |
1,550 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
98 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
95 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
68 |
68 |
$2K |
| D0330 |
Panoramic radiographic image |
71 |
71 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$918.32 |
| D0603 |
|
2,970 |
2,943 |
$0.00 |
| D0601 |
|
100 |
100 |
$0.00 |
| D0602 |
|
61 |
60 |
$0.00 |