| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,075 |
1,604 |
$348K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,570 |
7,330 |
$209K |
| D1351 |
Sealant - per tooth |
8,433 |
1,438 |
$201K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,319 |
1,280 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
6,333 |
6,065 |
$168K |
| D1120 |
Prophylaxis - child |
4,975 |
4,765 |
$165K |
| D1110 |
Prophylaxis - adult |
2,465 |
2,372 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,426 |
715 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,980 |
2,834 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
8,162 |
7,754 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,923 |
3,782 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,330 |
2,251 |
$51K |
| D1206 |
Topical application of fluoride varnish |
3,440 |
3,296 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,855 |
1,685 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,120 |
1,061 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
25 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
36 |
12 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
50 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
97 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
24 |
$362.26 |
| D0603 |
|
5,843 |
5,643 |
$72.09 |
| D0602 |
|
1,389 |
1,353 |
$0.01 |
| D0431 |
|
35 |
34 |
$0.00 |
| D1999 |
|
66 |
64 |
$0.00 |
| D0601 |
|
1,387 |
1,362 |
$0.00 |