| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,342 |
3,031 |
$599K |
| D1351 |
Sealant - per tooth |
12,095 |
3,415 |
$331K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,349 |
2,340 |
$329K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,274 |
2,287 |
$319K |
| D1120 |
Prophylaxis - child |
7,139 |
7,082 |
$256K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,734 |
8,509 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
7,812 |
7,751 |
$220K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,449 |
6,257 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,950 |
9,876 |
$143K |
| D1110 |
Prophylaxis - adult |
2,448 |
2,431 |
$131K |
| D0220 |
Intraoral - periapical first radiographic image |
9,072 |
8,956 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
680 |
371 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,631 |
2,600 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,116 |
1,109 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,917 |
1,900 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,413 |
2,395 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
191 |
$26K |
| D0350 |
|
1,772 |
1,755 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
272 |
$5K |
| D7111 |
|
232 |
168 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
29 |
$2K |
| D2330 |
|
20 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
69 |
69 |
$839.36 |
| D0603 |
|
12,890 |
12,786 |
$0.00 |