| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,455 |
745 |
$141K |
| D0145 |
Oral evaluation for a patient under three years of age |
699 |
689 |
$77K |
| D1351 |
Sealant - per tooth |
3,377 |
696 |
$71K |
| D1120 |
Prophylaxis - child |
2,224 |
2,168 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,383 |
4,099 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,137 |
2,082 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,525 |
2,431 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,755 |
4,563 |
$54K |
| D1110 |
Prophylaxis - adult |
1,258 |
1,214 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,515 |
1,465 |
$45K |
| D1206 |
Topical application of fluoride varnish |
3,422 |
3,341 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
554 |
303 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
139 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
230 |
79 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
825 |
768 |
$19K |
| D0272 |
Bitewings - two radiographic images |
832 |
816 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
218 |
$7K |
| D0330 |
Panoramic radiographic image |
70 |
70 |
$3K |
| D0603 |
|
2,359 |
2,305 |
$3K |
| D0602 |
|
832 |
817 |
$709.50 |
| D0601 |
|
880 |
855 |
$350.80 |