| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,899 |
3,535 |
$672K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,003 |
3,951 |
$552K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,805 |
3,593 |
$521K |
| D1351 |
Sealant - per tooth |
9,458 |
2,487 |
$255K |
| D1120 |
Prophylaxis - child |
7,026 |
6,973 |
$254K |
| D0120 |
Periodic oral evaluation - established patient |
7,771 |
7,724 |
$222K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,977 |
7,824 |
$203K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,507 |
5,376 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,740 |
9,670 |
$141K |
| D1110 |
Prophylaxis - adult |
2,273 |
2,261 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
1,574 |
1,565 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
8,466 |
8,385 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,793 |
1,771 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,603 |
2,588 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,732 |
1,720 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
43 |
$694.86 |
| D1330 |
|
66 |
66 |
$563.50 |
| D0603 |
|
14,523 |
14,379 |
$0.00 |