| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21,979 |
11,182 |
$1.73M |
| D0120 |
Periodic oral evaluation - established patient |
38,110 |
37,998 |
$1.09M |
| D0145 |
Oral evaluation for a patient under three years of age |
7,629 |
7,611 |
$1.08M |
| D1120 |
Prophylaxis - child |
26,539 |
26,461 |
$963K |
| D1110 |
Prophylaxis - adult |
13,382 |
13,333 |
$723K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,777 |
3,679 |
$590K |
| D1208 |
Topical application of fluoride, excluding varnish |
40,534 |
40,408 |
$588K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,122 |
16,988 |
$462K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,740 |
15,626 |
$422K |
| D0274 |
Bitewings - four radiographic images |
12,238 |
12,186 |
$392K |
| D0210 |
Intraoral - complete series of radiographic images |
4,391 |
4,387 |
$305K |
| D0272 |
Bitewings - two radiographic images |
10,385 |
10,362 |
$224K |
| D0220 |
Intraoral - periapical first radiographic image |
18,322 |
18,283 |
$201K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
440 |
275 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,194 |
1,183 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
419 |
418 |
$8K |
| D0330 |
Panoramic radiographic image |
1,341 |
1,340 |
$6K |
| D2330 |
|
60 |
46 |
$4K |
| D1351 |
Sealant - per tooth |
121 |
37 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D7111 |
|
12 |
12 |
$137.64 |
| D0602 |
|
24,670 |
24,614 |
$0.00 |
| D0603 |
|
24,297 |
24,198 |
$0.00 |