| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,497 |
2,667 |
$427K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,786 |
2,782 |
$391K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,278 |
11,514 |
$317K |
| D1120 |
Prophylaxis - child |
8,477 |
8,454 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
7,799 |
7,787 |
$221K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,631 |
11,602 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
11,668 |
11,621 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,221 |
661 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,196 |
4,150 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,125 |
3,104 |
$105K |
| D1110 |
Prophylaxis - adult |
1,951 |
1,948 |
$105K |
| D0272 |
Bitewings - two radiographic images |
3,870 |
3,859 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,052 |
2,045 |
$65K |
| D0330 |
Panoramic radiographic image |
517 |
510 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
24 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
86 |
$6K |
| D0603 |
|
6,529 |
6,499 |
$0.00 |
| D0602 |
|
8,438 |
8,413 |
$0.00 |