| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,941 |
1,499 |
$253K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,759 |
1,357 |
$224K |
| D1110 |
Prophylaxis - adult |
4,215 |
4,129 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
6,994 |
6,830 |
$180K |
| D1120 |
Prophylaxis - child |
4,993 |
4,912 |
$163K |
| D0274 |
Bitewings - four radiographic images |
4,507 |
4,423 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,449 |
8,329 |
$128K |
| D0145 |
Oral evaluation for a patient under three years of age |
768 |
761 |
$101K |
| D1351 |
Sealant - per tooth |
3,673 |
631 |
$97K |
| D0272 |
Bitewings - two radiographic images |
3,887 |
3,821 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,279 |
2,265 |
$76K |
| D0330 |
Panoramic radiographic image |
1,877 |
1,836 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,226 |
1,143 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
275 |
275 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$2K |
| D2330 |
|
30 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
16 |
$1K |
| D1206 |
Topical application of fluoride varnish |
55 |
51 |
$745.20 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$196.08 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$159.18 |
| D1999 |
|
279 |
262 |
$0.00 |
| D0603 |
|
5,645 |
5,521 |
$0.00 |
| D0602 |
|
769 |
762 |
$0.00 |
| D0601 |
|
252 |
248 |
$0.00 |