| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,773 |
1,937 |
$484K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,083 |
1,480 |
$243K |
| D1351 |
Sealant - per tooth |
5,887 |
1,714 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,964 |
2,948 |
$102K |
| D1120 |
Prophylaxis - child |
2,841 |
2,824 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,141 |
3,937 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
565 |
557 |
$78K |
| D1110 |
Prophylaxis - adult |
1,272 |
1,263 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,000 |
1,989 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,291 |
2,267 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,027 |
4,003 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,040 |
4,011 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,969 |
1,955 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,126 |
1,119 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
62 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |
| D0603 |
|
4,661 |
4,596 |
$0.00 |