| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,367 |
4,331 |
$1.05M |
| D0145 |
Oral evaluation for a patient under three years of age |
2,346 |
2,333 |
$329K |
| D0120 |
Periodic oral evaluation - established patient |
11,007 |
10,960 |
$314K |
| D1120 |
Prophylaxis - child |
8,033 |
7,999 |
$292K |
| D1351 |
Sealant - per tooth |
10,029 |
2,829 |
$276K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,873 |
1,469 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,150 |
11,774 |
$203K |
| D1110 |
Prophylaxis - adult |
3,135 |
3,118 |
$170K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,177 |
11,132 |
$163K |
| D0274 |
Bitewings - four radiographic images |
5,238 |
5,213 |
$162K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,932 |
4,861 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
12,569 |
12,492 |
$132K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
813 |
159 |
$119K |
| D0272 |
Bitewings - two radiographic images |
3,307 |
3,294 |
$70K |
| D9248 |
|
311 |
307 |
$37K |
| D0330 |
Panoramic radiographic image |
1,238 |
1,230 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
188 |
188 |
$13K |
| D1206 |
Topical application of fluoride varnish |
790 |
781 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
326 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
127 |
41 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$469.50 |
| D0603 |
|
15,355 |
15,280 |
$0.00 |