| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,218 |
2,523 |
$396K |
| D1351 |
Sealant - per tooth |
7,908 |
1,818 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,744 |
1,675 |
$159K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,264 |
1,240 |
$139K |
| D1120 |
Prophylaxis - child |
3,871 |
3,788 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,202 |
4,110 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,261 |
5,282 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,582 |
5,450 |
$61K |
| D1110 |
Prophylaxis - adult |
1,535 |
1,493 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,574 |
2,499 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
5,641 |
5,485 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,468 |
1,415 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,029 |
1,815 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,187 |
1,160 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
249 |
235 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
64 |
$14K |
| D0330 |
Panoramic radiographic image |
903 |
880 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$304.56 |
| D0603 |
|
6,227 |
6,078 |
$28.86 |
| D0602 |
|
585 |
575 |
$0.00 |