| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,656 |
1,316 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,762 |
1,065 |
$128K |
| D0145 |
Oral evaluation for a patient under three years of age |
844 |
828 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,108 |
4,030 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,660 |
4,272 |
$112K |
| D1351 |
Sealant - per tooth |
4,360 |
1,166 |
$106K |
| D1110 |
Prophylaxis - adult |
1,814 |
1,785 |
$95K |
| D1120 |
Prophylaxis - child |
2,523 |
2,467 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,287 |
4,197 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,858 |
1,824 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,444 |
4,333 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,105 |
2,063 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
521 |
483 |
$13K |
| D0330 |
Panoramic radiographic image |
224 |
217 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
14 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
27 |
$911.26 |
| D0603 |
|
3,998 |
3,934 |
$0.00 |
| D0602 |
|
1,033 |
1,015 |
$0.00 |
| D0601 |
|
69 |
69 |
$0.00 |