| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,311 |
1,816 |
$537K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,342 |
1,039 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,764 |
3,346 |
$95K |
| D1351 |
Sealant - per tooth |
3,298 |
1,034 |
$87K |
| D1120 |
Prophylaxis - child |
2,355 |
2,316 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,290 |
2,253 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
469 |
464 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,140 |
2,105 |
$56K |
| D1110 |
Prophylaxis - adult |
998 |
989 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,434 |
3,386 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,438 |
1,424 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,446 |
3,383 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,113 |
1,094 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,246 |
1,228 |
$29K |
| D0350 |
|
1,487 |
1,454 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
150 |
86 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
72 |
33 |
$10K |
| D2330 |
|
91 |
49 |
$7K |
| D7111 |
|
16 |
13 |
$183.52 |
| D0603 |
|
4,001 |
3,926 |
$0.00 |