| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,031 |
2,982 |
$681K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,620 |
2,035 |
$347K |
| D0120 |
Periodic oral evaluation - established patient |
11,274 |
11,017 |
$313K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,632 |
12,352 |
$283K |
| D1110 |
Prophylaxis - adult |
5,070 |
4,921 |
$264K |
| D1120 |
Prophylaxis - child |
6,370 |
6,250 |
$226K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,592 |
12,320 |
$179K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,197 |
1,173 |
$164K |
| D0274 |
Bitewings - four radiographic images |
5,168 |
5,012 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
13,012 |
12,683 |
$141K |
| D1351 |
Sealant - per tooth |
4,809 |
1,215 |
$127K |
| D7240 |
Removal of impacted tooth - completely bony |
275 |
82 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,618 |
2,553 |
$55K |
| D0350 |
|
3,288 |
3,182 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
513 |
512 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
789 |
747 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
472 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
105 |
32 |
$15K |
| D0330 |
Panoramic radiographic image |
1,099 |
1,052 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
38 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
147 |
$3K |
| D1330 |
|
221 |
210 |
$2K |
| D0603 |
|
14,971 |
14,665 |
$0.00 |
| D0602 |
|
16 |
15 |
$0.00 |