| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
5,347 |
389 |
$356K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,329 |
340 |
$352K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
702 |
176 |
$147K |
| D1351 |
Sealant - per tooth |
1,309 |
231 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
79 |
$56K |
| D2940 |
|
295 |
86 |
$46K |
| D9920 |
|
281 |
267 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
507 |
424 |
$39K |
| D1120 |
Prophylaxis - child |
597 |
582 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
436 |
418 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,278 |
512 |
$27K |
| D1206 |
Topical application of fluoride varnish |
703 |
681 |
$23K |
| D0160 |
|
168 |
164 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
559 |
527 |
$14K |
| D0272 |
Bitewings - two radiographic images |
300 |
293 |
$11K |
| D0274 |
Bitewings - four radiographic images |
157 |
149 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
54 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
58 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$684.42 |
| D0601 |
|
737 |
713 |
$0.00 |