| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,706 |
3,823 |
$740K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,882 |
2,739 |
$367K |
| D1351 |
Sealant - per tooth |
10,094 |
2,848 |
$261K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,116 |
8,155 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,309 |
6,084 |
$206K |
| D1120 |
Prophylaxis - child |
5,500 |
5,329 |
$190K |
| D0274 |
Bitewings - four radiographic images |
4,665 |
4,522 |
$153K |
| D1110 |
Prophylaxis - adult |
2,877 |
2,778 |
$149K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,434 |
8,156 |
$117K |
| D0145 |
Oral evaluation for a patient under three years of age |
864 |
821 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
8,492 |
8,205 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
2,119 |
2,071 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,142 |
2,076 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
191 |
115 |
$24K |
| D2332 |
|
123 |
74 |
$14K |
| D2330 |
|
77 |
33 |
$5K |
| D2335 |
|
20 |
12 |
$3K |
| D0603 |
|
5,957 |
5,762 |
$0.00 |
| D0601 |
|
1,535 |
1,479 |
$0.00 |
| D0602 |
|
2,022 |
1,934 |
$0.00 |
| D1999 |
|
377 |
370 |
$0.00 |