| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,166 |
1,499 |
$223K |
| D1351 |
Sealant - per tooth |
9,036 |
1,796 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
6,982 |
6,815 |
$149K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,241 |
1,229 |
$119K |
| D1120 |
Prophylaxis - child |
4,320 |
4,231 |
$111K |
| D1110 |
Prophylaxis - adult |
2,783 |
2,723 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,806 |
996 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,257 |
3,175 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,647 |
7,283 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
7,849 |
7,602 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,596 |
5,483 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,202 |
3,096 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,128 |
979 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,510 |
1,471 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
146 |
81 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
93 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
304 |
298 |
$7K |
| D0350 |
|
660 |
659 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
73 |
$965.82 |
| D1330 |
|
1,468 |
1,433 |
$851.59 |
| D0240 |
|
81 |
79 |
$485.10 |
| D9310 |
|
46 |
45 |
$284.31 |
| D0603 |
|
8,237 |
8,072 |
$22.61 |
| D0601 |
|
350 |
306 |
$0.28 |
| D0602 |
|
261 |
258 |
$0.09 |