| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,082 |
473 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
766 |
390 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,904 |
1,809 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,921 |
2,972 |
$50K |
| D1110 |
Prophylaxis - adult |
944 |
905 |
$47K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
343 |
159 |
$47K |
| D1120 |
Prophylaxis - child |
1,344 |
1,279 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,295 |
3,066 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,124 |
1,072 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,637 |
2,503 |
$35K |
| D1351 |
Sealant - per tooth |
1,303 |
368 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
239 |
215 |
$28K |
| D9248 |
|
191 |
175 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
852 |
769 |
$20K |
| D0272 |
Bitewings - two radiographic images |
923 |
888 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
510 |
$16K |
| D0330 |
Panoramic radiographic image |
28 |
26 |
$1K |
| D3120 |
|
29 |
12 |
$28.67 |
| D0602 |
|
1,815 |
1,718 |
$0.00 |
| D0601 |
|
301 |
283 |
$0.00 |
| D0603 |
|
734 |
696 |
$0.00 |