| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,317 |
1,443 |
$412K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,373 |
874 |
$255K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,780 |
1,754 |
$246K |
| D1351 |
Sealant - per tooth |
6,569 |
1,552 |
$171K |
| D1120 |
Prophylaxis - child |
3,492 |
3,425 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,987 |
3,881 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,997 |
4,594 |
$79K |
| D1110 |
Prophylaxis - adult |
1,522 |
1,475 |
$78K |
| D0274 |
Bitewings - four radiographic images |
3,060 |
2,972 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,191 |
5,067 |
$72K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
429 |
137 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
5,046 |
4,885 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,458 |
1,416 |
$47K |
| D9248 |
|
301 |
273 |
$33K |
| D0330 |
Panoramic radiographic image |
1,139 |
1,095 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,482 |
1,448 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
345 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
568 |
550 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
45 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
112 |
$2K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$598.29 |
| D7111 |
|
53 |
33 |
$561.14 |
| D9986 |
|
28 |
25 |
$0.00 |
| D0603 |
|
7,710 |
7,572 |
$0.00 |