| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,399 |
2,593 |
$530K |
| D1351 |
Sealant - per tooth |
14,084 |
2,976 |
$360K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,497 |
2,486 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
10,722 |
10,662 |
$300K |
| D1120 |
Prophylaxis - child |
7,347 |
7,315 |
$261K |
| D1110 |
Prophylaxis - adult |
4,900 |
4,866 |
$256K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,865 |
12,798 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,314 |
1,275 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,459 |
11,835 |
$166K |
| D0274 |
Bitewings - four radiographic images |
5,053 |
5,016 |
$165K |
| D0220 |
Intraoral - periapical first radiographic image |
12,539 |
12,418 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
1,662 |
1,650 |
$112K |
| D0272 |
Bitewings - two radiographic images |
4,773 |
4,754 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,221 |
2,198 |
$76K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
332 |
60 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,465 |
1,435 |
$39K |
| D0330 |
Panoramic radiographic image |
219 |
217 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
139 |
$2K |
| D0603 |
|
17,038 |
16,955 |
$0.00 |