| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,990 |
2,604 |
$687K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,094 |
2,295 |
$520K |
| D0210 |
Intraoral - complete series of radiographic images |
2,407 |
2,384 |
$165K |
| D1120 |
Prophylaxis - child |
3,962 |
3,881 |
$139K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
853 |
318 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,336 |
3,283 |
$114K |
| D1110 |
Prophylaxis - adult |
1,904 |
1,889 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,017 |
5,865 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,612 |
2,554 |
$73K |
| D0145 |
Oral evaluation for a patient under three years of age |
436 |
433 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,329 |
2,224 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,723 |
1,680 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,907 |
3,457 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,619 |
3,480 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,369 |
1,342 |
$31K |
| D1351 |
Sealant - per tooth |
1,215 |
365 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
170 |
129 |
$15K |
| D2332 |
|
97 |
49 |
$12K |
| D2330 |
|
113 |
74 |
$8K |
| D7111 |
|
77 |
50 |
$745.55 |
| D0603 |
|
6,651 |
6,490 |
$0.00 |