| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,853 |
2,543 |
$577K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,893 |
1,931 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
6,730 |
6,586 |
$187K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,860 |
5,651 |
$151K |
| D1120 |
Prophylaxis - child |
4,145 |
4,061 |
$146K |
| D1110 |
Prophylaxis - adult |
2,647 |
2,595 |
$139K |
| D0145 |
Oral evaluation for a patient under three years of age |
894 |
881 |
$124K |
| D1351 |
Sealant - per tooth |
4,670 |
1,140 |
$123K |
| D0274 |
Bitewings - four radiographic images |
3,172 |
3,102 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,095 |
6,941 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,519 |
3,402 |
$92K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
563 |
232 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
6,372 |
6,202 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
842 |
832 |
$56K |
| D2332 |
|
333 |
166 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,072 |
1,048 |
$24K |
| D0330 |
Panoramic radiographic image |
215 |
207 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
88 |
$6K |
| D9248 |
|
44 |
44 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
140 |
$5K |
| D2330 |
|
17 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$413.16 |
| D7111 |
|
31 |
12 |
$298.22 |
| D0603 |
|
8,220 |
8,079 |
$0.00 |