| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,146 |
1,831 |
$392K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,679 |
1,656 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
7,753 |
7,603 |
$212K |
| D1120 |
Prophylaxis - child |
5,298 |
5,178 |
$183K |
| D1110 |
Prophylaxis - adult |
3,405 |
3,348 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,933 |
7,310 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,975 |
8,801 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,289 |
3,231 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
7,857 |
7,646 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
926 |
558 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
991 |
957 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,411 |
2,270 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,165 |
2,121 |
$48K |
| D1351 |
Sealant - per tooth |
1,755 |
334 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,228 |
1,177 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
254 |
66 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
109 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
46 |
14 |
$13K |
| D2330 |
|
50 |
27 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
195 |
$4K |
| D9248 |
|
14 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$829.14 |
| D0603 |
|
11,315 |
11,063 |
$0.00 |
| D9986 |
|
94 |
89 |
$0.00 |
| D9996 |
|
20 |
20 |
$0.00 |