| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,902 |
2,489 |
$470K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,961 |
1,938 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
8,787 |
8,741 |
$244K |
| D1351 |
Sealant - per tooth |
8,954 |
1,767 |
$242K |
| D1120 |
Prophylaxis - child |
6,432 |
6,395 |
$226K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,428 |
9,244 |
$170K |
| D1110 |
Prophylaxis - adult |
3,046 |
3,029 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,682 |
9,627 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
10,052 |
9,937 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,549 |
3,526 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,097 |
676 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,400 |
3,379 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,503 |
2,220 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
478 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
116 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
192 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
244 |
242 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
14 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
14 |
$1K |
| D0350 |
|
57 |
57 |
$753.58 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$396.90 |
| D9986 |
|
217 |
206 |
$0.00 |
| D0603 |
|
6,063 |
6,039 |
$0.00 |
| D0602 |
|
4,662 |
4,620 |
$0.00 |
| D0601 |
|
835 |
823 |
$0.00 |