| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,384 |
1,012 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
2,936 |
2,907 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
557 |
555 |
$78K |
| D1120 |
Prophylaxis - child |
1,805 |
1,786 |
$65K |
| D1351 |
Sealant - per tooth |
2,346 |
687 |
$63K |
| D1110 |
Prophylaxis - adult |
999 |
989 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,089 |
3,059 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,026 |
1,803 |
$44K |
| D0274 |
Bitewings - four radiographic images |
986 |
973 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,333 |
2,278 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
198 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,071 |
1,056 |
$23K |
| D2330 |
|
57 |
34 |
$4K |
| D0330 |
Panoramic radiographic image |
129 |
128 |
$3K |
| D2335 |
|
25 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$847.68 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
16 |
$338.04 |
| D7111 |
|
26 |
12 |
$252.34 |
| D0603 |
|
2,184 |
2,172 |
$0.01 |
| D0601 |
|
957 |
952 |
$0.00 |
| D0602 |
|
181 |
181 |
$0.00 |