| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,604 |
749 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,107 |
4,034 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
4,305 |
4,213 |
$119K |
| D1351 |
Sealant - per tooth |
4,308 |
791 |
$112K |
| D1110 |
Prophylaxis - adult |
2,094 |
2,047 |
$108K |
| D1120 |
Prophylaxis - child |
2,534 |
2,487 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,195 |
577 |
$87K |
| D0145 |
Oral evaluation for a patient under three years of age |
536 |
515 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,571 |
4,479 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,857 |
1,807 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,373 |
4,266 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
537 |
508 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
576 |
539 |
$18K |
| D0272 |
Bitewings - two radiographic images |
673 |
671 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32 |
13 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
121 |
116 |
$3K |
| D1206 |
Topical application of fluoride varnish |
56 |
55 |
$779.10 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$464.32 |
| D0603 |
|
5,633 |
5,504 |
$216.69 |
| D0602 |
|
214 |
211 |
$9.04 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
172 |
154 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |
| 98971 |
|
169 |
152 |
$0.00 |
| D1999 |
|
3,898 |
3,543 |
$0.00 |
| 99072 |
|
169 |
152 |
$0.00 |
| 98970 |
|
168 |
151 |
$0.00 |