| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,824 |
1,987 |
$459K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,242 |
7,230 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
7,271 |
7,089 |
$201K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,424 |
1,410 |
$196K |
| D1120 |
Prophylaxis - child |
4,715 |
4,642 |
$166K |
| D0274 |
Bitewings - four radiographic images |
3,953 |
3,837 |
$128K |
| D1110 |
Prophylaxis - adult |
2,419 |
2,375 |
$126K |
| D1351 |
Sealant - per tooth |
4,389 |
1,257 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,566 |
7,447 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,268 |
655 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
7,679 |
7,478 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
865 |
827 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
951 |
899 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,115 |
1,098 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
220 |
110 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
134 |
28 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
755 |
726 |
$19K |
| D1330 |
|
554 |
540 |
$5K |
| D0170 |
|
251 |
238 |
$3K |
| D0350 |
|
204 |
182 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
57 |
$1K |
| D9248 |
|
13 |
13 |
$609.40 |
| D4355 |
|
15 |
14 |
$573.28 |
| D0603 |
|
10,351 |
10,174 |
$0.00 |