| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,944 |
1,023 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,336 |
748 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,379 |
3,306 |
$93K |
| D1110 |
Prophylaxis - adult |
1,594 |
1,559 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
576 |
573 |
$80K |
| D1120 |
Prophylaxis - child |
2,029 |
1,990 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,955 |
2,869 |
$64K |
| D1351 |
Sealant - per tooth |
2,333 |
629 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,750 |
3,669 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,635 |
1,600 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,212 |
3,116 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
558 |
545 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,251 |
1,221 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
220 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
41 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
265 |
232 |
$7K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$222.08 |
| D0603 |
|
4,731 |
4,628 |
$0.00 |