| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,003 |
2,268 |
$496K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,761 |
1,747 |
$247K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,540 |
6,778 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,003 |
5,949 |
$170K |
| D1120 |
Prophylaxis - child |
4,378 |
4,332 |
$156K |
| D1351 |
Sealant - per tooth |
4,831 |
1,482 |
$134K |
| D1110 |
Prophylaxis - adult |
2,288 |
2,266 |
$122K |
| D0274 |
Bitewings - four radiographic images |
3,610 |
3,573 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,777 |
6,708 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,541 |
3,205 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
7,253 |
7,125 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
804 |
466 |
$62K |
| D0350 |
|
3,554 |
3,490 |
$56K |
| D0330 |
Panoramic radiographic image |
1,232 |
1,218 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
711 |
691 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
369 |
369 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,171 |
1,161 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
49 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
146 |
$3K |
| D7111 |
|
75 |
51 |
$837.31 |
| D0603 |
|
8,875 |
8,777 |
$0.00 |