| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,173 |
1,476 |
$268K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,280 |
1,169 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,016 |
4,662 |
$135K |
| D1351 |
Sealant - per tooth |
5,446 |
1,260 |
$131K |
| D0145 |
Oral evaluation for a patient under three years of age |
943 |
906 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
4,272 |
3,933 |
$109K |
| D1120 |
Prophylaxis - child |
3,252 |
3,000 |
$102K |
| D1110 |
Prophylaxis - adult |
1,694 |
1,580 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,664 |
2,465 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,656 |
2,238 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
5,471 |
4,962 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,183 |
3,111 |
$44K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
311 |
194 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,742 |
1,454 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
577 |
540 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
297 |
297 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
106 |
79 |
$8K |
| D0272 |
Bitewings - two radiographic images |
259 |
244 |
$5K |
| D0330 |
Panoramic radiographic image |
406 |
391 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
153 |
$3K |
| D0603 |
|
4,858 |
4,556 |
$0.00 |
| D0601 |
|
992 |
951 |
$0.00 |
| D0602 |
|
28 |
26 |
$0.00 |