| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,169 |
1,842 |
$393K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,048 |
1,101 |
$153K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,754 |
4,430 |
$104K |
| D1351 |
Sealant - per tooth |
3,871 |
1,015 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,545 |
3,489 |
$98K |
| D1110 |
Prophylaxis - adult |
1,757 |
1,727 |
$90K |
| D1120 |
Prophylaxis - child |
2,232 |
2,185 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,046 |
2,006 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,241 |
4,157 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,858 |
4,680 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
304 |
301 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,494 |
1,473 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,141 |
1,062 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
762 |
740 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
249 |
148 |
$20K |
| D0330 |
Panoramic radiographic image |
552 |
536 |
$15K |
| D0350 |
|
851 |
823 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
13 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$3K |
| D1330 |
|
215 |
213 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$525.84 |
| D0603 |
|
5,139 |
5,058 |
$0.00 |
| D0602 |
|
128 |
127 |
$0.00 |