| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,980 |
2,273 |
$483K |
| D1351 |
Sealant - per tooth |
9,122 |
2,525 |
$237K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,682 |
1,671 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
7,423 |
7,277 |
$207K |
| D1120 |
Prophylaxis - child |
5,229 |
5,146 |
$185K |
| D1110 |
Prophylaxis - adult |
2,341 |
2,308 |
$123K |
| D0274 |
Bitewings - four radiographic images |
3,732 |
3,655 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,952 |
7,830 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,371 |
781 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
7,903 |
7,734 |
$96K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
567 |
181 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,433 |
7,299 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,161 |
3,120 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
121 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
88 |
27 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
283 |
268 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
171 |
$6K |
| D9248 |
|
48 |
46 |
$5K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$671.69 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$262.92 |
| D0603 |
|
3,747 |
3,685 |
$0.00 |
| D0601 |
|
3,056 |
3,009 |
$0.00 |
| D0602 |
|
2,794 |
2,757 |
$0.00 |
| D9986 |
|
13 |
13 |
$0.00 |