| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,700 |
874 |
$352K |
| D0120 |
Periodic oral evaluation - established patient |
4,518 |
4,406 |
$126K |
| D1120 |
Prophylaxis - child |
2,869 |
2,801 |
$100K |
| D1110 |
Prophylaxis - adult |
1,853 |
1,801 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,328 |
419 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,194 |
5,063 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,082 |
3,000 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,164 |
1,123 |
$35K |
| D1351 |
Sealant - per tooth |
1,226 |
231 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
961 |
905 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
171 |
169 |
$24K |
| D0240 |
|
1,958 |
1,017 |
$18K |
| D0330 |
Panoramic radiographic image |
524 |
496 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
280 |
255 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
39 |
$429.92 |
| D0603 |
|
2,523 |
2,453 |
$0.00 |
| D0601 |
|
2,480 |
2,431 |
$0.00 |
| D0602 |
|
210 |
207 |
$0.00 |
| D1999 |
|
101 |
90 |
$0.00 |