| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
2,157 |
1,106 |
$228K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
505 |
271 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,259 |
1,224 |
$53K |
| D1120 |
Prophylaxis - child |
1,162 |
1,149 |
$48K |
| D1110 |
Prophylaxis - adult |
759 |
746 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,818 |
1,792 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
292 |
165 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,216 |
2,172 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
884 |
881 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
381 |
373 |
$22K |
| D1206 |
Topical application of fluoride varnish |
852 |
839 |
$22K |
| D8660 |
|
138 |
138 |
$20K |
| D0274 |
Bitewings - four radiographic images |
606 |
596 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
72 |
13 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
567 |
562 |
$7K |
| D0272 |
Bitewings - two radiographic images |
273 |
270 |
$6K |
| D2950 |
|
32 |
25 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
80 |
$3K |
| D1351 |
Sealant - per tooth |
88 |
29 |
$3K |
| D0330 |
Panoramic radiographic image |
52 |
49 |
$3K |
| D0460 |
|
67 |
65 |
$2K |
| D0340 |
|
31 |
31 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
44 |
43 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
15 |
$511.20 |