| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,869 |
1,079 |
$373K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,459 |
1,443 |
$197K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,003 |
675 |
$146K |
| D1120 |
Prophylaxis - child |
3,262 |
3,206 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
2,841 |
2,819 |
$77K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
517 |
81 |
$67K |
| D1351 |
Sealant - per tooth |
2,748 |
575 |
$65K |
| D1110 |
Prophylaxis - adult |
1,259 |
1,245 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,638 |
4,564 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,813 |
1,762 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
824 |
803 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,381 |
1,362 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,410 |
3,363 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,582 |
3,277 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,209 |
1,150 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,153 |
1,137 |
$25K |
| D9248 |
|
66 |
65 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
75 |
17 |
$5K |
| D2330 |
|
41 |
18 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0603 |
|
6,524 |
6,427 |
$0.00 |
| D1999 |
|
147 |
139 |
$0.00 |