| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,699 |
4,809 |
$1.25M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,568 |
4,240 |
$812K |
| D0210 |
Intraoral - complete series of radiographic images |
5,344 |
5,252 |
$355K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,468 |
2,435 |
$337K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,389 |
7,271 |
$245K |
| D1120 |
Prophylaxis - child |
6,698 |
6,633 |
$238K |
| D1351 |
Sealant - per tooth |
7,318 |
2,168 |
$188K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,837 |
5,725 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,692 |
9,591 |
$138K |
| D1110 |
Prophylaxis - adult |
2,568 |
2,534 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,308 |
4,205 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
2,541 |
2,512 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
4,473 |
4,416 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,077 |
1,072 |
$35K |
| D0272 |
Bitewings - two radiographic images |
720 |
713 |
$16K |
| D2330 |
|
89 |
62 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
44 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
27 |
$6K |
| D2332 |
|
20 |
13 |
$3K |
| D1330 |
|
133 |
132 |
$1K |
| D0350 |
|
86 |
85 |
$832.52 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$768.72 |
| D1352 |
|
28 |
13 |
$666.48 |
| D0603 |
|
13,255 |
12,954 |
$0.00 |
| D0601 |
|
60 |
60 |
$0.00 |