| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,699 |
1,048 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
4,242 |
4,024 |
$113K |
| D1351 |
Sealant - per tooth |
4,250 |
841 |
$99K |
| D1110 |
Prophylaxis - adult |
1,913 |
1,823 |
$97K |
| D1120 |
Prophylaxis - child |
2,657 |
2,525 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,711 |
4,480 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
908 |
457 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,910 |
1,822 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,239 |
4,290 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,717 |
4,449 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
376 |
366 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,337 |
2,205 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
418 |
355 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
84 |
$5K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
39 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$244.14 |
| D0601 |
|
2,154 |
2,077 |
$0.00 |
| D0603 |
|
909 |
855 |
$0.00 |
| D0602 |
|
1,839 |
1,719 |
$0.00 |