| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,568 |
3,658 |
$750K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,818 |
2,783 |
$385K |
| D0120 |
Periodic oral evaluation - established patient |
11,726 |
11,635 |
$332K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,346 |
13,101 |
$317K |
| D1120 |
Prophylaxis - child |
8,630 |
8,546 |
$309K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,326 |
2,156 |
$259K |
| D0274 |
Bitewings - four radiographic images |
6,547 |
6,471 |
$204K |
| D1110 |
Prophylaxis - adult |
3,669 |
3,630 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,900 |
12,776 |
$185K |
| D0220 |
Intraoral - periapical first radiographic image |
13,611 |
13,447 |
$160K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,090 |
5,831 |
$158K |
| D1351 |
Sealant - per tooth |
3,974 |
1,155 |
$103K |
| D0272 |
Bitewings - two radiographic images |
1,646 |
1,623 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
302 |
187 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
811 |
786 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
170 |
67 |
$25K |
| D9248 |
|
59 |
54 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
121 |
$2K |
| D0330 |
Panoramic radiographic image |
243 |
231 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D0160 |
|
44 |
41 |
$627.70 |
| D1206 |
Topical application of fluoride varnish |
43 |
43 |
$617.40 |
| D0603 |
|
17,526 |
17,316 |
$120.23 |
| D1330 |
|
240 |
239 |
$24.50 |