| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,963 |
1,708 |
$480K |
| D1351 |
Sealant - per tooth |
8,843 |
1,935 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
4,772 |
4,697 |
$133K |
| D1120 |
Prophylaxis - child |
3,673 |
3,606 |
$130K |
| D1110 |
Prophylaxis - adult |
2,218 |
2,183 |
$116K |
| D0145 |
Oral evaluation for a patient under three years of age |
801 |
793 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
1,478 |
1,455 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,858 |
5,757 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,241 |
2,203 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,578 |
4,115 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,536 |
2,388 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,466 |
4,367 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,640 |
1,608 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,068 |
1,039 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
178 |
$28K |
| D2335 |
|
162 |
85 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
84 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
55 |
$1K |
| D0602 |
|
1,589 |
1,573 |
$1.05 |
| D0601 |
|
3,723 |
3,677 |
$0.01 |
| D0603 |
|
1,342 |
1,324 |
$0.01 |