| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,627 |
1,823 |
$559K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,625 |
755 |
$124K |
| D0145 |
Oral evaluation for a patient under three years of age |
655 |
651 |
$91K |
| D1120 |
Prophylaxis - child |
1,975 |
1,953 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,176 |
2,154 |
$61K |
| D1351 |
Sealant - per tooth |
2,165 |
602 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,039 |
2,993 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,839 |
1,822 |
$39K |
| D1110 |
Prophylaxis - adult |
649 |
637 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,113 |
1,071 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
592 |
581 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,886 |
1,854 |
$19K |
| D0274 |
Bitewings - four radiographic images |
604 |
592 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,634 |
1,605 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$3K |
| D0330 |
Panoramic radiographic image |
257 |
253 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
13 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
13 |
$2K |
| D0603 |
|
1,310 |
1,293 |
$90.17 |
| D0602 |
|
2,337 |
2,316 |
$18.14 |
| D0601 |
|
105 |
105 |
$0.00 |