| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,296 |
3,600 |
$894K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,394 |
4,184 |
$860K |
| D0210 |
Intraoral - complete series of radiographic images |
3,987 |
3,913 |
$270K |
| D1351 |
Sealant - per tooth |
9,881 |
2,613 |
$261K |
| D1120 |
Prophylaxis - child |
5,640 |
5,544 |
$200K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,956 |
5,822 |
$152K |
| D1110 |
Prophylaxis - adult |
2,869 |
2,814 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,468 |
4,486 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,910 |
3,821 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
4,666 |
4,602 |
$131K |
| D0145 |
Oral evaluation for a patient under three years of age |
908 |
895 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,543 |
8,398 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
4,896 |
4,753 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,582 |
1,560 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,255 |
1,233 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
12 |
$3K |
| D9248 |
|
14 |
12 |
$1K |
| D0160 |
|
73 |
68 |
$852.15 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$169.02 |
| D0603 |
|
9,914 |
9,744 |
$0.00 |