| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,367 |
8,295 |
$2.07M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,784 |
2,341 |
$1.05M |
| D0145 |
Oral evaluation for a patient under three years of age |
6,671 |
6,589 |
$916K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,389 |
5,279 |
$768K |
| D1120 |
Prophylaxis - child |
15,395 |
15,125 |
$534K |
| D0120 |
Periodic oral evaluation - established patient |
18,358 |
18,045 |
$509K |
| D1351 |
Sealant - per tooth |
16,814 |
5,425 |
$442K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,740 |
18,924 |
$338K |
| D1110 |
Prophylaxis - adult |
5,250 |
5,143 |
$269K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,829 |
9,410 |
$255K |
| D0274 |
Bitewings - four radiographic images |
8,122 |
7,957 |
$253K |
| D0220 |
Intraoral - periapical first radiographic image |
20,820 |
20,280 |
$247K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,966 |
14,663 |
$210K |
| D0272 |
Bitewings - two radiographic images |
7,454 |
7,339 |
$163K |
| D9248 |
|
1,204 |
1,143 |
$121K |
| D1206 |
Topical application of fluoride varnish |
5,253 |
5,197 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,069 |
2,001 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,420 |
1,370 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
84 |
$14K |
| D2332 |
|
77 |
35 |
$9K |
| D2330 |
|
78 |
50 |
$6K |
| D0330 |
Panoramic radiographic image |
114 |
111 |
$4K |
| D7111 |
|
308 |
211 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$894.25 |
| D0270 |
|
15 |
15 |
$68.60 |
| D0603 |
|
27,274 |
26,842 |
$0.00 |