| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,780 |
832 |
$173K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,271 |
630 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
637 |
293 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,713 |
3,360 |
$72K |
| D0145 |
Oral evaluation for a patient under three years of age |
521 |
510 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,394 |
2,349 |
$66K |
| D1120 |
Prophylaxis - child |
1,641 |
1,607 |
$57K |
| D1351 |
Sealant - per tooth |
1,899 |
547 |
$51K |
| D1110 |
Prophylaxis - adult |
967 |
954 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,512 |
3,433 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,765 |
2,711 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,136 |
1,117 |
$37K |
| D9248 |
|
315 |
300 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,312 |
1,246 |
$34K |
| D0272 |
Bitewings - two radiographic images |
941 |
919 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
408 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$597.94 |
| D0603 |
|
2,167 |
2,133 |
$0.00 |
| D0601 |
|
54 |
53 |
$0.00 |
| D0602 |
|
1,184 |
1,154 |
$0.00 |
| D9986 |
|
13 |
13 |
$0.00 |