| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,938 |
1,039 |
$189K |
| D0145 |
Oral evaluation for a patient under three years of age |
774 |
767 |
$108K |
| D1351 |
Sealant - per tooth |
3,522 |
1,054 |
$96K |
| D1120 |
Prophylaxis - child |
2,494 |
2,452 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,907 |
2,871 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,857 |
3,194 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
944 |
642 |
$73K |
| D1110 |
Prophylaxis - adult |
1,247 |
1,238 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,608 |
1,591 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,766 |
3,717 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,373 |
3,319 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,382 |
1,316 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
462 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
780 |
770 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,164 |
1,153 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
123 |
68 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
29 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$244.14 |
| D0350 |
|
12 |
12 |
$220.56 |
| D0603 |
|
3,309 |
3,268 |
$0.00 |
| D0602 |
|
1,218 |
1,204 |
$0.00 |