| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,042 |
892 |
$294K |
| D1351 |
Sealant - per tooth |
5,280 |
912 |
$131K |
| D0145 |
Oral evaluation for a patient under three years of age |
912 |
897 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,352 |
3,272 |
$92K |
| D1120 |
Prophylaxis - child |
2,633 |
2,571 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,039 |
3,198 |
$65K |
| D1110 |
Prophylaxis - adult |
1,242 |
1,212 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,882 |
3,792 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,340 |
1,308 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,426 |
3,324 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,113 |
1,024 |
$28K |
| D0330 |
Panoramic radiographic image |
446 |
438 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,104 |
1,084 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
350 |
334 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
14 |
$3K |
| D0270 |
|
443 |
435 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
38 |
$692.98 |
| D0603 |
|
2,293 |
2,263 |
$0.00 |
| D0602 |
|
2,409 |
2,356 |
$0.00 |