| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,861 |
7,623 |
$1.65M |
| D0145 |
Oral evaluation for a patient under three years of age |
6,763 |
6,704 |
$943K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,226 |
4,105 |
$640K |
| D1120 |
Prophylaxis - child |
13,555 |
13,409 |
$483K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,904 |
14,531 |
$421K |
| D0120 |
Periodic oral evaluation - established patient |
13,080 |
12,954 |
$370K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,780 |
11,209 |
$307K |
| D1351 |
Sealant - per tooth |
10,696 |
3,233 |
$288K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,766 |
17,580 |
$255K |
| D0220 |
Intraoral - periapical first radiographic image |
15,676 |
15,470 |
$191K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,262 |
629 |
$181K |
| D1110 |
Prophylaxis - adult |
2,929 |
2,906 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,339 |
4,258 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
2,180 |
2,156 |
$146K |
| D0274 |
Bitewings - four radiographic images |
3,163 |
3,112 |
$103K |
| D0272 |
Bitewings - two radiographic images |
3,668 |
3,638 |
$84K |
| D2330 |
|
195 |
112 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
318 |
315 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
14 |
$896.84 |
| D0603 |
|
25,536 |
25,336 |
$0.00 |
| D0602 |
|
170 |
169 |
$0.00 |
| D0601 |
|
70 |
70 |
$0.00 |