| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,662 |
513 |
$190K |
| D0145 |
Oral evaluation for a patient under three years of age |
897 |
886 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,435 |
396 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,722 |
2,362 |
$58K |
| D1120 |
Prophylaxis - child |
1,665 |
1,654 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,856 |
1,842 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,411 |
2,393 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
1,034 |
$32K |
| D1110 |
Prophylaxis - adult |
626 |
617 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,485 |
2,449 |
$28K |
| D2330 |
|
447 |
172 |
$23K |
| D0350 |
|
2,139 |
2,119 |
$21K |
| D2332 |
|
238 |
96 |
$20K |
| D1351 |
Sealant - per tooth |
772 |
172 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
530 |
515 |
$15K |
| D2331 |
|
125 |
47 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
254 |
245 |
$7K |
| D0272 |
Bitewings - two radiographic images |
184 |
181 |
$4K |
| D0330 |
Panoramic radiographic image |
192 |
192 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$1K |
| D1330 |
|
12 |
12 |
$24.50 |
| D0603 |
|
3,694 |
3,651 |
$0.00 |