| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,036 |
1,501 |
$389K |
| D0120 |
Periodic oral evaluation - established patient |
3,193 |
3,124 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,487 |
2,436 |
$70K |
| D1120 |
Prophylaxis - child |
2,005 |
1,945 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,243 |
3,859 |
$68K |
| D1110 |
Prophylaxis - adult |
1,271 |
1,255 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
630 |
360 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,111 |
3,995 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,997 |
2,929 |
$42K |
| D1351 |
Sealant - per tooth |
1,283 |
370 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
247 |
244 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
595 |
565 |
$19K |
| D0272 |
Bitewings - two radiographic images |
706 |
690 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
68 |
$11K |
| D0330 |
Panoramic radiographic image |
770 |
736 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
83 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
279 |
275 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
133 |
114 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
15 |
$345.80 |
| D1999 |
|
1,922 |
1,654 |
$0.00 |
| D0603 |
|
3,695 |
3,625 |
$0.00 |
| D0601 |
|
359 |
346 |
$0.00 |
| D0602 |
|
25 |
21 |
$0.00 |