| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,245 |
891 |
$222K |
| D0145 |
Oral evaluation for a patient under three years of age |
599 |
594 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
988 |
471 |
$76K |
| D1120 |
Prophylaxis - child |
1,824 |
1,793 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,826 |
1,784 |
$62K |
| D1351 |
Sealant - per tooth |
2,091 |
572 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,425 |
3,563 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,717 |
2,672 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,289 |
1,280 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,254 |
1,221 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,811 |
3,754 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,045 |
1,028 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
174 |
41 |
$25K |
| D0330 |
Panoramic radiographic image |
1,127 |
1,097 |
$25K |
| D0272 |
Bitewings - two radiographic images |
933 |
921 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
142 |
$10K |
| D9248 |
|
66 |
66 |
$8K |
| D1110 |
Prophylaxis - adult |
128 |
119 |
$6K |
| D0603 |
|
4,983 |
4,920 |
$0.00 |