| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,449 |
1,010 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,096 |
4,743 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,940 |
1,023 |
$142K |
| D1351 |
Sealant - per tooth |
5,345 |
989 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
4,500 |
4,343 |
$123K |
| D0145 |
Oral evaluation for a patient under three years of age |
893 |
873 |
$122K |
| D1120 |
Prophylaxis - child |
3,275 |
3,155 |
$114K |
| D1110 |
Prophylaxis - adult |
1,594 |
1,530 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
5,195 |
4,955 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
406 |
149 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,662 |
1,562 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,862 |
2,699 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,078 |
997 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,034 |
2,022 |
$29K |
| D0272 |
Bitewings - two radiographic images |
954 |
936 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
286 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
80 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$706.93 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$242.26 |
| D0431 |
|
146 |
107 |
$27.00 |
| D0603 |
|
3,838 |
3,672 |
$0.00 |
| D0602 |
|
1,742 |
1,737 |
$0.00 |
| D0601 |
|
238 |
238 |
$0.00 |