| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,760 |
2,043 |
$363K |
| D0120 |
Periodic oral evaluation - established patient |
11,009 |
10,906 |
$308K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,049 |
2,034 |
$281K |
| D1110 |
Prophylaxis - adult |
5,013 |
4,955 |
$265K |
| D1120 |
Prophylaxis - child |
6,939 |
6,869 |
$245K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,614 |
579 |
$232K |
| D0272 |
Bitewings - two radiographic images |
9,976 |
9,887 |
$215K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,136 |
9,552 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,509 |
1,544 |
$190K |
| D1351 |
Sealant - per tooth |
6,940 |
1,844 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,938 |
11,809 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
10,222 |
10,089 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
572 |
563 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,316 |
1,207 |
$34K |
| D9248 |
|
212 |
211 |
$25K |
| D0330 |
Panoramic radiographic image |
800 |
796 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
668 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
130 |
$20K |
| D0250 |
|
657 |
645 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
97 |
$2K |
| D1330 |
|
102 |
102 |
$1K |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$484.54 |
| D1352 |
|
15 |
13 |
$449.28 |
| D1999 |
|
993 |
861 |
$10.00 |
| D0603 |
|
12,405 |
12,268 |
$0.00 |
| D0602 |
|
1,353 |
1,339 |
$0.00 |
| D0601 |
|
316 |
316 |
$0.00 |