| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28,497 |
8,455 |
$2.89M |
| D1351 |
Sealant - per tooth |
12,025 |
3,884 |
$333K |
| D0210 |
Intraoral - complete series of radiographic images |
4,324 |
4,295 |
$301K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,626 |
8,562 |
$301K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,631 |
2,298 |
$283K |
| D1120 |
Prophylaxis - child |
6,830 |
6,776 |
$244K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,144 |
9,041 |
$241K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,471 |
1,462 |
$205K |
| D1110 |
Prophylaxis - adult |
3,498 |
3,470 |
$185K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,224 |
5,778 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,169 |
10,088 |
$147K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
768 |
507 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,281 |
2,257 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
5,963 |
5,858 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,587 |
1,568 |
$45K |
| D0272 |
Bitewings - two radiographic images |
750 |
742 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
83 |
56 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
41 |
26 |
$3K |
| D0603 |
|
11,826 |
11,717 |
$0.00 |