| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,523 |
1,212 |
$221K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,266 |
1,221 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
4,557 |
4,381 |
$120K |
| D1120 |
Prophylaxis - child |
3,374 |
3,247 |
$113K |
| D1351 |
Sealant - per tooth |
4,264 |
861 |
$102K |
| D1110 |
Prophylaxis - adult |
1,821 |
1,743 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,092 |
4,909 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,734 |
1,539 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,965 |
1,893 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,043 |
989 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
459 |
273 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
383 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
246 |
169 |
$11K |
| D0330 |
Panoramic radiographic image |
98 |
92 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
210 |
199 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
85 |
$1K |
| D0240 |
|
139 |
67 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0601 |
|
2,923 |
2,815 |
$0.00 |
| D0603 |
|
2,318 |
2,266 |
$0.00 |
| D0602 |
|
1,105 |
1,082 |
$0.00 |