| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,136 |
1,343 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
6,675 |
6,304 |
$169K |
| D1110 |
Prophylaxis - adult |
3,425 |
3,221 |
$156K |
| D1120 |
Prophylaxis - child |
3,581 |
3,418 |
$115K |
| D0145 |
Oral evaluation for a patient under three years of age |
838 |
803 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,321 |
3,110 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,008 |
6,642 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
7,484 |
6,909 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,364 |
6,729 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,159 |
3,007 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,020 |
569 |
$64K |
| D1351 |
Sealant - per tooth |
1,909 |
348 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
153 |
52 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,660 |
1,410 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
216 |
126 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
565 |
507 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
161 |
$10K |
| D9248 |
|
71 |
65 |
$7K |
| D7230 |
|
38 |
12 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
142 |
139 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
77 |
$1K |
| D0330 |
Panoramic radiographic image |
23 |
21 |
$223.24 |
| D0603 |
|
8,954 |
8,554 |
$0.00 |