| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,414 |
1,180 |
$381K |
| D0145 |
Oral evaluation for a patient under three years of age |
794 |
771 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,155 |
449 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
861 |
831 |
$55K |
| D1120 |
Prophylaxis - child |
1,597 |
1,523 |
$51K |
| D1351 |
Sealant - per tooth |
1,786 |
465 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,251 |
1,166 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,519 |
1,383 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,173 |
2,071 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,359 |
915 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
891 |
852 |
$23K |
| D1110 |
Prophylaxis - adult |
344 |
330 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
162 |
73 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,097 |
1,036 |
$12K |
| D0272 |
Bitewings - two radiographic images |
341 |
327 |
$7K |
| D0274 |
Bitewings - four radiographic images |
185 |
178 |
$6K |
| D1330 |
|
85 |
81 |
$833.00 |
| D0330 |
Panoramic radiographic image |
23 |
17 |
$396.94 |
| D0603 |
|
3,369 |
3,249 |
$0.00 |