| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,877 |
1,124 |
$285K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,450 |
1,429 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
4,398 |
4,350 |
$124K |
| D1120 |
Prophylaxis - child |
2,823 |
2,789 |
$99K |
| D1110 |
Prophylaxis - adult |
1,665 |
1,649 |
$88K |
| D1351 |
Sealant - per tooth |
2,975 |
802 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,706 |
4,655 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,619 |
1,598 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
616 |
307 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,603 |
1,587 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,966 |
877 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,400 |
1,344 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
102 |
31 |
$15K |
| D0330 |
Panoramic radiographic image |
353 |
344 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
86 |
30 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
70 |
$2K |
| D2330 |
|
19 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$694.86 |
| D0603 |
|
3,011 |
2,978 |
$0.13 |
| D0601 |
|
1,355 |
1,336 |
$0.11 |
| D0602 |
|
1,530 |
1,512 |
$0.05 |