| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,261 |
4,893 |
$727K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,620 |
3,311 |
$573K |
| D1351 |
Sealant - per tooth |
13,323 |
4,294 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
11,440 |
11,364 |
$326K |
| D1110 |
Prophylaxis - adult |
5,759 |
5,720 |
$311K |
| D1120 |
Prophylaxis - child |
5,843 |
5,805 |
$211K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,208 |
6,945 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,720 |
11,644 |
$170K |
| D0274 |
Bitewings - four radiographic images |
4,696 |
4,671 |
$160K |
| D0272 |
Bitewings - two radiographic images |
5,797 |
5,757 |
$124K |
| D0145 |
Oral evaluation for a patient under three years of age |
846 |
843 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
1,155 |
1,147 |
$80K |
| D0350 |
|
3,573 |
3,503 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
212 |
122 |
$31K |
| D0330 |
Panoramic radiographic image |
879 |
872 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,230 |
1,210 |
$15K |
| D2330 |
|
87 |
57 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
97 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$847.68 |
| D0603 |
|
12,983 |
12,893 |
$0.00 |