| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,690 |
1,628 |
$258K |
| D1351 |
Sealant - per tooth |
7,404 |
1,966 |
$195K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,255 |
1,497 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
5,697 |
5,614 |
$158K |
| D1110 |
Prophylaxis - adult |
2,973 |
2,927 |
$155K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,060 |
1,044 |
$146K |
| D1120 |
Prophylaxis - child |
3,415 |
3,356 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,028 |
2,973 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,322 |
6,218 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,046 |
5,164 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,050 |
1,019 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,459 |
5,370 |
$66K |
| D0272 |
Bitewings - two radiographic images |
1,790 |
1,770 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
745 |
714 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
956 |
889 |
$24K |
| D7240 |
Removal of impacted tooth - completely bony |
94 |
29 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
60 |
$7K |
| D7111 |
|
27 |
12 |
$309.69 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$262.92 |
| D0603 |
|
5,444 |
5,374 |
$0.00 |
| D0602 |
|
1,805 |
1,780 |
$0.00 |
| D0601 |
|
45 |
45 |
$0.00 |
| D9986 |
|
189 |
187 |
$0.00 |