| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,374 |
616 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,919 |
3,359 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,289 |
3,216 |
$90K |
| D1120 |
Prophylaxis - child |
2,249 |
2,200 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
542 |
533 |
$73K |
| D1351 |
Sealant - per tooth |
2,481 |
652 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
832 |
446 |
$64K |
| D1110 |
Prophylaxis - adult |
1,036 |
1,016 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,709 |
3,634 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,588 |
3,467 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,076 |
1,026 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,056 |
1,031 |
$24K |
| D0272 |
Bitewings - two radiographic images |
792 |
776 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
342 |
341 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
16 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
124 |
$4K |
| D9248 |
|
60 |
58 |
$3K |
| D0170 |
|
30 |
29 |
$463.12 |
| D0603 |
|
4,346 |
4,263 |
$0.00 |
| D0602 |
|
179 |
176 |
$0.00 |