| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,378 |
2,034 |
$421K |
| D1351 |
Sealant - per tooth |
10,826 |
2,526 |
$281K |
| D1120 |
Prophylaxis - child |
7,125 |
7,014 |
$250K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,528 |
8,445 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
8,800 |
8,644 |
$243K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,708 |
1,676 |
$233K |
| D1110 |
Prophylaxis - adult |
3,268 |
3,205 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,799 |
10,613 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,977 |
1,135 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
1,966 |
1,930 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,672 |
3,596 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
9,002 |
8,817 |
$106K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
414 |
66 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,693 |
1,661 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,198 |
2,170 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,623 |
1,500 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
218 |
134 |
$22K |
| D9248 |
|
55 |
54 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
121 |
$2K |
| D1330 |
|
29 |
29 |
$306.25 |
| D0603 |
|
13,043 |
12,804 |
$0.00 |