| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,003 |
2,089 |
$567K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,246 |
1,240 |
$172K |
| D1120 |
Prophylaxis - child |
4,126 |
4,094 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
5,223 |
5,171 |
$142K |
| D1110 |
Prophylaxis - adult |
2,309 |
2,290 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,391 |
6,341 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,628 |
2,600 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,174 |
1,159 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
913 |
427 |
$69K |
| D0272 |
Bitewings - two radiographic images |
1,931 |
1,917 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,251 |
1,238 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,204 |
1,178 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
70 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
85 |
13 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
678 |
379 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
74 |
73 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$737.61 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
49 |
$713.64 |
| D1330 |
|
26 |
25 |
$49.00 |
| D0603 |
|
8,290 |
8,227 |
$0.00 |