| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,484 |
2,733 |
$616K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,053 |
1,417 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
7,613 |
7,433 |
$209K |
| D1120 |
Prophylaxis - child |
5,916 |
5,775 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,674 |
7,882 |
$157K |
| D1110 |
Prophylaxis - adult |
2,905 |
2,826 |
$147K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,053 |
1,027 |
$142K |
| D0274 |
Bitewings - four radiographic images |
3,559 |
3,460 |
$115K |
| D1206 |
Topical application of fluoride varnish |
7,949 |
7,764 |
$111K |
| D1351 |
Sealant - per tooth |
3,928 |
845 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
8,617 |
8,365 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,438 |
3,297 |
$88K |
| D0272 |
Bitewings - two radiographic images |
2,486 |
2,427 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
786 |
761 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
369 |
363 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
101 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
778 |
759 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
43 |
$807.54 |
| D0330 |
Panoramic radiographic image |
16 |
14 |
$195.60 |
| D0603 |
|
10,326 |
10,104 |
$0.00 |