| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,891 |
3,087 |
$728K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,703 |
3,674 |
$513K |
| D1120 |
Prophylaxis - child |
5,391 |
5,338 |
$192K |
| D1351 |
Sealant - per tooth |
7,522 |
1,856 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
5,448 |
5,392 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,674 |
1,026 |
$118K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,580 |
3,940 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,298 |
7,224 |
$104K |
| D1110 |
Prophylaxis - adult |
1,822 |
1,806 |
$97K |
| D0272 |
Bitewings - two radiographic images |
3,928 |
3,881 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,283 |
1,268 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,701 |
1,679 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,080 |
3,979 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,357 |
1,347 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
241 |
158 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,613 |
1,585 |
$18K |
| D1330 |
|
1,558 |
1,498 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
54 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
428 |
405 |
$7K |
| D2332 |
|
16 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
15 |
$2K |
| D0601 |
|
3,540 |
3,511 |
$0.00 |
| D0603 |
|
2,475 |
2,446 |
$0.00 |
| D0602 |
|
4,889 |
4,849 |
$0.00 |