| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,827 |
1,926 |
$582K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,232 |
871 |
$172K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,633 |
4,098 |
$152K |
| D1351 |
Sealant - per tooth |
4,610 |
1,277 |
$125K |
| D0145 |
Oral evaluation for a patient under three years of age |
891 |
870 |
$122K |
| D1120 |
Prophylaxis - child |
2,667 |
2,634 |
$95K |
| D0272 |
Bitewings - two radiographic images |
3,305 |
3,253 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,080 |
2,050 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,514 |
2,474 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,659 |
2,524 |
$70K |
| D1110 |
Prophylaxis - adult |
1,177 |
1,154 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,059 |
4,002 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,415 |
4,322 |
$54K |
| D0240 |
|
1,423 |
712 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
59 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
118 |
$8K |
| D0330 |
Panoramic radiographic image |
96 |
96 |
$6K |
| D2330 |
|
19 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
16 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$694.86 |
| D0603 |
|
5,982 |
5,879 |
$0.00 |
| D9986 |
|
13 |
13 |
$0.00 |