| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,613 |
3,390 |
$478K |
| D0120 |
Periodic oral evaluation - established patient |
8,323 |
8,134 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,979 |
1,781 |
$166K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,564 |
1,544 |
$163K |
| D1120 |
Prophylaxis - child |
5,726 |
5,626 |
$149K |
| D1110 |
Prophylaxis - adult |
3,872 |
3,802 |
$148K |
| D1351 |
Sealant - per tooth |
6,396 |
1,495 |
$118K |
| D0274 |
Bitewings - four radiographic images |
4,247 |
4,152 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
972 |
611 |
$102K |
| D1206 |
Topical application of fluoride varnish |
8,852 |
8,709 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,511 |
8,880 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
9,447 |
9,175 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,473 |
3,407 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,954 |
1,880 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
297 |
204 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
474 |
441 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
770 |
748 |
$8K |
| D2330 |
|
23 |
12 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
96 |
$989.90 |
| D0350 |
|
151 |
116 |
$481.55 |
| D0603 |
|
12,008 |
11,673 |
$26.20 |