| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,531 |
1,914 |
$241K |
| D1351 |
Sealant - per tooth |
9,954 |
2,118 |
$188K |
| D1120 |
Prophylaxis - child |
4,889 |
4,808 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,158 |
1,436 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
5,098 |
5,020 |
$104K |
| D1110 |
Prophylaxis - adult |
2,567 |
2,558 |
$98K |
| D0145 |
Oral evaluation for a patient under three years of age |
862 |
858 |
$73K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
700 |
313 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,564 |
2,549 |
$65K |
| D0274 |
Bitewings - four radiographic images |
3,171 |
3,142 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,192 |
5,120 |
$52K |
| D0272 |
Bitewings - two radiographic images |
3,379 |
3,329 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
5,691 |
5,606 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,547 |
5,105 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
535 |
535 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,751 |
1,575 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
350 |
244 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,845 |
1,814 |
$18K |
| D0330 |
Panoramic radiographic image |
1,720 |
1,711 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
391 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
71 |
16 |
$3K |
| D0350 |
|
33 |
32 |
$196.66 |
| D0603 |
|
7,172 |
7,069 |
$36.30 |
| D0601 |
|
930 |
927 |
$0.01 |
| D0602 |
|
243 |
243 |
$0.00 |
| D1999 |
|
330 |
277 |
$0.00 |