| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,314 |
3,185 |
$807K |
| D1351 |
Sealant - per tooth |
7,078 |
2,023 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
2,801 |
2,735 |
$188K |
| D1120 |
Prophylaxis - child |
4,921 |
4,834 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,461 |
4,006 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,128 |
4,041 |
$138K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,427 |
4,336 |
$115K |
| D0145 |
Oral evaluation for a patient under three years of age |
842 |
821 |
$110K |
| D1110 |
Prophylaxis - adult |
1,864 |
1,836 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,881 |
6,765 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,254 |
847 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,785 |
2,748 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
4,131 |
4,070 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,333 |
1,313 |
$42K |
| D0272 |
Bitewings - two radiographic images |
803 |
794 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
72 |
13 |
$10K |
| D0160 |
|
51 |
50 |
$583.05 |
| D9248 |
|
22 |
14 |
$487.52 |
| D9243 |
|
30 |
12 |
$427.80 |
| D9239 |
|
14 |
12 |
$399.28 |
| D9612 |
|
12 |
12 |
$250.81 |
| D1330 |
|
26 |
25 |
$171.50 |
| D0170 |
|
16 |
13 |
$82.37 |
| D0603 |
|
8,027 |
7,816 |
$0.00 |