| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,859 |
813 |
$175K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,091 |
1,075 |
$149K |
| D1351 |
Sealant - per tooth |
4,434 |
810 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
4,228 |
4,066 |
$109K |
| D1120 |
Prophylaxis - child |
3,047 |
2,932 |
$100K |
| D1110 |
Prophylaxis - adult |
1,857 |
1,773 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,831 |
4,633 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,059 |
1,954 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
5,254 |
4,976 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
727 |
310 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,424 |
2,336 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,026 |
4,723 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
837 |
760 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
431 |
409 |
$14K |
| D1206 |
Topical application of fluoride varnish |
49 |
48 |
$685.02 |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$496.99 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$225.36 |
| D9986 |
|
76 |
73 |
$0.00 |
| D0603 |
|
6,455 |
6,253 |
$0.00 |