| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,412 |
1,584 |
$332K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,946 |
1,945 |
$270K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,177 |
978 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
5,462 |
5,378 |
$153K |
| D1120 |
Prophylaxis - child |
3,925 |
3,873 |
$140K |
| D1110 |
Prophylaxis - adult |
2,356 |
2,301 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,409 |
6,244 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,106 |
6,015 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,745 |
2,673 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
6,678 |
6,489 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,002 |
1,851 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
366 |
104 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,040 |
2,010 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
921 |
877 |
$29K |
| D9248 |
|
266 |
253 |
$28K |
| D0330 |
Panoramic radiographic image |
1,190 |
1,149 |
$19K |
| D1330 |
|
1,280 |
1,231 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
135 |
$9K |
| D1351 |
Sealant - per tooth |
277 |
68 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
33 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$682.36 |
| D9310 |
|
26 |
26 |
$262.44 |
| D0170 |
|
14 |
14 |
$231.56 |
| D0603 |
|
8,228 |
8,156 |
$0.00 |
| D0601 |
|
68 |
68 |
$0.00 |
| D3120 |
|
55 |
42 |
$0.00 |