| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,175 |
988 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
3,909 |
3,832 |
$108K |
| D0145 |
Oral evaluation for a patient under three years of age |
794 |
779 |
$108K |
| D1120 |
Prophylaxis - child |
2,958 |
2,912 |
$104K |
| D1351 |
Sealant - per tooth |
3,095 |
738 |
$82K |
| D1110 |
Prophylaxis - adult |
1,565 |
1,526 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,476 |
4,393 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,586 |
2,549 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,548 |
4,442 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,516 |
1,478 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,468 |
4,297 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
901 |
763 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
141 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
430 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
96 |
54 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
69 |
38 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$187.80 |
| D0603 |
|
5,338 |
5,261 |
$0.00 |