| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,922 |
1,213 |
$267K |
| D1110 |
Prophylaxis - adult |
3,276 |
3,211 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
5,752 |
5,574 |
$154K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,091 |
1,066 |
$145K |
| D1120 |
Prophylaxis - child |
3,625 |
3,505 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,762 |
3,664 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,981 |
6,793 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,065 |
5,383 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
5,882 |
5,677 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
912 |
480 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
631 |
618 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,191 |
1,165 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,386 |
1,313 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,586 |
1,541 |
$35K |
| D7240 |
Removal of impacted tooth - completely bony |
115 |
32 |
$31K |
| D1351 |
Sealant - per tooth |
586 |
103 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
211 |
209 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
104 |
59 |
$9K |
| D9248 |
|
31 |
31 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
116 |
$2K |
| D1330 |
|
24 |
22 |
$12.25 |
| D0603 |
|
8,542 |
8,313 |
$0.05 |
| D9986 |
|
149 |
135 |
$0.00 |