| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,305 |
1,133 |
$219K |
| D0120 |
Periodic oral evaluation - established patient |
3,286 |
3,208 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,141 |
558 |
$86K |
| D1110 |
Prophylaxis - adult |
1,485 |
1,449 |
$78K |
| D1120 |
Prophylaxis - child |
2,190 |
2,136 |
$76K |
| D0145 |
Oral evaluation for a patient under three years of age |
546 |
537 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,628 |
3,543 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,561 |
1,521 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,560 |
3,522 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,858 |
3,725 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,571 |
1,302 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,710 |
1,671 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
254 |
$9K |
| D1351 |
Sealant - per tooth |
58 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
14 |
$988.96 |
| D0140 |
Limited oral evaluation - problem focused |
43 |
41 |
$713.64 |
| D1330 |
|
29 |
28 |
$12.25 |
| D0602 |
|
1,046 |
1,032 |
$0.00 |
| D0603 |
|
484 |
475 |
$0.00 |
| D0601 |
|
2,699 |
2,657 |
$0.00 |
| D9986 |
|
45 |
42 |
$0.00 |
| D9987 |
|
18 |
17 |
$0.00 |