| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,344 |
4,113 |
$708K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,663 |
4,006 |
$578K |
| D9248 |
|
3,827 |
3,584 |
$447K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,963 |
1,421 |
$428K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,852 |
2,839 |
$400K |
| D0120 |
Periodic oral evaluation - established patient |
11,507 |
11,378 |
$326K |
| D1120 |
Prophylaxis - child |
8,707 |
8,624 |
$313K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,125 |
8,708 |
$307K |
| D1351 |
Sealant - per tooth |
7,114 |
2,672 |
$196K |
| D1110 |
Prophylaxis - adult |
3,472 |
3,431 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,146 |
12,003 |
$175K |
| D0220 |
Intraoral - periapical first radiographic image |
10,151 |
9,826 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,429 |
3,372 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,634 |
3,443 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
469 |
340 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,319 |
1,301 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
745 |
729 |
$25K |
| D1330 |
|
2,086 |
2,075 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
218 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
138 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
374 |
359 |
$7K |
| D0330 |
Panoramic radiographic image |
156 |
155 |
$4K |
| D2330 |
|
52 |
39 |
$4K |
| D0350 |
|
303 |
293 |
$3K |
| D0603 |
|
14,984 |
14,894 |
$0.00 |
| D0602 |
|
27 |
27 |
$0.00 |
| D9986 |
|
246 |
238 |
$0.00 |