| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,818 |
2,642 |
$454K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,346 |
9,926 |
$249K |
| D0120 |
Periodic oral evaluation - established patient |
9,045 |
8,843 |
$244K |
| D1120 |
Prophylaxis - child |
5,955 |
5,806 |
$203K |
| D1110 |
Prophylaxis - adult |
3,686 |
3,614 |
$188K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,238 |
1,221 |
$165K |
| D0274 |
Bitewings - four radiographic images |
5,925 |
5,756 |
$154K |
| D1351 |
Sealant - per tooth |
5,738 |
1,271 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,646 |
9,440 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,815 |
1,247 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
10,715 |
10,364 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
561 |
321 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
652 |
463 |
$64K |
| D0330 |
Panoramic radiographic image |
1,803 |
1,753 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
499 |
497 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
959 |
872 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
629 |
614 |
$21K |
| D0272 |
Bitewings - two radiographic images |
981 |
960 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
461 |
443 |
$8K |
| D2332 |
|
22 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
111 |
110 |
$2K |
| D0350 |
|
198 |
190 |
$2K |
| D7111 |
|
59 |
39 |
$619.38 |
| D0603 |
|
10,048 |
9,848 |
$0.00 |
| D0602 |
|
1,172 |
1,140 |
$0.00 |
| D0601 |
|
201 |
199 |
$0.00 |