| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,735 |
2,951 |
$560K |
| D0120 |
Periodic oral evaluation - established patient |
14,386 |
14,183 |
$405K |
| D1351 |
Sealant - per tooth |
12,850 |
3,652 |
$351K |
| D1120 |
Prophylaxis - child |
9,142 |
9,022 |
$328K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,132 |
2,369 |
$319K |
| D1110 |
Prophylaxis - adult |
4,472 |
4,407 |
$238K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,666 |
1,654 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,374 |
14,174 |
$206K |
| D0272 |
Bitewings - two radiographic images |
7,925 |
7,827 |
$178K |
| D0220 |
Intraoral - periapical first radiographic image |
14,453 |
14,238 |
$171K |
| D0274 |
Bitewings - four radiographic images |
4,956 |
4,883 |
$153K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,977 |
13,693 |
$152K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,257 |
5,086 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
474 |
470 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
100 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
41 |
$11K |
| D0330 |
Panoramic radiographic image |
929 |
912 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
164 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
45 |
27 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
115 |
$2K |
| D1330 |
|
22 |
22 |
$61.25 |
| D0603 |
|
13,369 |
13,280 |
$0.00 |
| D0602 |
|
3,192 |
3,156 |
$0.00 |
| D0601 |
|
33 |
33 |
$0.00 |