| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,330 |
511 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,215 |
3,132 |
$86K |
| D1110 |
Prophylaxis - adult |
1,690 |
1,649 |
$85K |
| D1120 |
Prophylaxis - child |
2,070 |
2,006 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,925 |
3,823 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,712 |
3,832 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,770 |
1,711 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
314 |
312 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,157 |
3,989 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,336 |
1,294 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
158 |
$24K |
| D1351 |
Sealant - per tooth |
695 |
176 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
436 |
$15K |
| D0330 |
Panoramic radiographic image |
593 |
563 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
81 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
24 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
98 |
$3K |
| D0603 |
|
3,086 |
3,018 |
$0.01 |
| D0601 |
|
931 |
912 |
$0.00 |
| D0602 |
|
123 |
121 |
$0.00 |