| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,776 |
2,486 |
$674K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,027 |
3,950 |
$555K |
| D1120 |
Prophylaxis - child |
10,438 |
10,353 |
$376K |
| D0120 |
Periodic oral evaluation - established patient |
12,386 |
12,267 |
$350K |
| D1351 |
Sealant - per tooth |
12,386 |
2,741 |
$342K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,012 |
14,619 |
$314K |
| D1110 |
Prophylaxis - adult |
4,857 |
4,806 |
$259K |
| D0274 |
Bitewings - four radiographic images |
7,568 |
7,496 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,401 |
15,256 |
$222K |
| D0220 |
Intraoral - periapical first radiographic image |
15,658 |
15,387 |
$173K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
852 |
225 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,266 |
3,225 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,754 |
736 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
1,006 |
1,001 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,751 |
2,732 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,084 |
2,021 |
$54K |
| D9248 |
|
483 |
467 |
$53K |
| D0330 |
Panoramic radiographic image |
2,808 |
2,773 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
715 |
698 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
41 |
12 |
$12K |
| D9310 |
|
1,013 |
1,009 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
27 |
$5K |
| D9420 |
|
59 |
58 |
$2K |
| D1330 |
|
148 |
146 |
$2K |
| D0350 |
|
28 |
27 |
$253.64 |
| D0603 |
|
20,334 |
19,973 |
$0.00 |