| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,581 |
518 |
$147K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,028 |
1,003 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,821 |
2,901 |
$81K |
| D1351 |
Sealant - per tooth |
2,409 |
423 |
$62K |
| D1120 |
Prophylaxis - child |
1,795 |
1,751 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,900 |
1,838 |
$50K |
| D1110 |
Prophylaxis - adult |
875 |
846 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,439 |
1,377 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,223 |
1,132 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,737 |
2,664 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,265 |
3,077 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
252 |
93 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
282 |
97 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
598 |
527 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
40 |
$8K |
| D0272 |
Bitewings - two radiographic images |
310 |
304 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$7K |
| D0330 |
Panoramic radiographic image |
209 |
189 |
$2K |
| D0350 |
|
74 |
73 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$272.02 |
| D0603 |
|
3,757 |
3,683 |
$153.18 |
| D0601 |
|
187 |
186 |
$0.00 |
| D0602 |
|
28 |
28 |
$0.00 |