| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27,315 |
9,574 |
$2.78M |
| D1351 |
Sealant - per tooth |
37,082 |
7,855 |
$1.01M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,421 |
12,274 |
$428K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,057 |
2,981 |
$397K |
| D1120 |
Prophylaxis - child |
8,994 |
8,875 |
$324K |
| D0274 |
Bitewings - four radiographic images |
8,554 |
8,437 |
$291K |
| D1110 |
Prophylaxis - adult |
5,157 |
5,093 |
$277K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,823 |
1,796 |
$254K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,122 |
13,938 |
$204K |
| D0220 |
Intraoral - periapical first radiographic image |
13,689 |
13,511 |
$169K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,688 |
13,506 |
$155K |
| D0272 |
Bitewings - two radiographic images |
5,132 |
5,077 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
1,846 |
1,813 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
435 |
434 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
67 |
25 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$377.46 |
| D0603 |
|
16,014 |
15,743 |
$0.00 |