| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,135 |
2,975 |
$590K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,964 |
2,954 |
$414K |
| D1120 |
Prophylaxis - child |
7,311 |
7,258 |
$260K |
| D1351 |
Sealant - per tooth |
8,858 |
2,561 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
7,652 |
7,596 |
$217K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,703 |
1,624 |
$201K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,042 |
5,906 |
$159K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,427 |
7,282 |
$158K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,222 |
10,143 |
$147K |
| D0220 |
Intraoral - periapical first radiographic image |
8,002 |
7,926 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
1,352 |
1,335 |
$90K |
| D1110 |
Prophylaxis - adult |
1,701 |
1,687 |
$89K |
| D0272 |
Bitewings - two radiographic images |
3,803 |
3,784 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,797 |
1,781 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
301 |
166 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,276 |
1,265 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
54 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$694.86 |
| D0350 |
|
30 |
28 |
$441.12 |
| D0603 |
|
14,811 |
14,720 |
$0.00 |