| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,517 |
1,244 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,731 |
1,274 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
4,350 |
4,335 |
$124K |
| D1110 |
Prophylaxis - adult |
1,856 |
1,852 |
$101K |
| D1120 |
Prophylaxis - child |
2,770 |
2,757 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,227 |
3,962 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,598 |
4,582 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
422 |
422 |
$60K |
| D1351 |
Sealant - per tooth |
2,002 |
406 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,517 |
1,513 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,077 |
4,047 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
569 |
568 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,448 |
1,443 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
178 |
$5K |
| D9248 |
|
43 |
39 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$3K |
| D0350 |
|
119 |
116 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0603 |
|
4,748 |
4,730 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0601 |
|
265 |
265 |
$0.00 |