| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,750 |
3,245 |
$769K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,755 |
1,748 |
$245K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,181 |
1,465 |
$244K |
| D1351 |
Sealant - per tooth |
8,114 |
2,018 |
$219K |
| D1120 |
Prophylaxis - child |
5,301 |
5,247 |
$187K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,888 |
5,171 |
$174K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,037 |
4,887 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,193 |
3,159 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
3,510 |
3,469 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,869 |
6,792 |
$98K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
582 |
210 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,173 |
1,164 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,571 |
5,501 |
$68K |
| D1110 |
Prophylaxis - adult |
590 |
581 |
$31K |
| D0274 |
Bitewings - four radiographic images |
589 |
584 |
$20K |
| D0272 |
Bitewings - two radiographic images |
346 |
340 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$469.50 |
| D0603 |
|
10,139 |
10,042 |
$0.00 |