| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,241 |
588 |
$116K |
| D0145 |
Oral evaluation for a patient under three years of age |
823 |
793 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,020 |
468 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,795 |
2,745 |
$75K |
| D1120 |
Prophylaxis - child |
2,195 |
2,139 |
$73K |
| D1110 |
Prophylaxis - adult |
1,174 |
1,148 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,895 |
2,518 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,145 |
3,074 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
600 |
577 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,794 |
2,726 |
$33K |
| D0274 |
Bitewings - four radiographic images |
798 |
781 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
645 |
603 |
$20K |
| D0272 |
Bitewings - two radiographic images |
698 |
689 |
$16K |
| D1351 |
Sealant - per tooth |
328 |
63 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
41 |
$1K |
| D1330 |
|
62 |
59 |
$328.56 |
| D0601 |
|
1,540 |
1,485 |
$6.03 |
| D0603 |
|
2,340 |
2,290 |
$4.01 |
| D0602 |
|
519 |
512 |
$0.00 |