| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,507 |
1,827 |
$327K |
| D1351 |
Sealant - per tooth |
7,848 |
1,773 |
$211K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,310 |
1,295 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
5,193 |
5,165 |
$144K |
| D1120 |
Prophylaxis - child |
3,999 |
3,978 |
$140K |
| D1110 |
Prophylaxis - adult |
2,220 |
2,197 |
$115K |
| D1206 |
Topical application of fluoride varnish |
6,092 |
6,055 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,131 |
740 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,095 |
2,081 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,305 |
5,232 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,097 |
4,914 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,240 |
3,226 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
441 |
312 |
$40K |
| D0330 |
Panoramic radiographic image |
1,091 |
1,081 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
958 |
934 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,083 |
1,034 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
331 |
327 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
75 |
52 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
169 |
$3K |
| D0603 |
|
7,630 |
7,568 |
$0.00 |
| D0602 |
|
46 |
46 |
$0.00 |