| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,840 |
4,637 |
$867K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,628 |
3,277 |
$436K |
| D0120 |
Periodic oral evaluation - established patient |
12,456 |
12,338 |
$353K |
| D1120 |
Prophylaxis - child |
8,621 |
8,553 |
$294K |
| D1110 |
Prophylaxis - adult |
5,108 |
5,056 |
$274K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,933 |
1,913 |
$270K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,768 |
8,940 |
$255K |
| D1351 |
Sealant - per tooth |
8,791 |
2,891 |
$241K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,133 |
13,015 |
$190K |
| D0274 |
Bitewings - four radiographic images |
5,086 |
5,039 |
$163K |
| D0272 |
Bitewings - two radiographic images |
6,599 |
6,547 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
13,721 |
13,527 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,659 |
12,494 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
830 |
619 |
$83K |
| D0330 |
Panoramic radiographic image |
2,444 |
2,409 |
$79K |
| D1330 |
|
3,991 |
3,938 |
$47K |
| D2331 |
|
201 |
140 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
338 |
$12K |
| D7111 |
|
1,037 |
556 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
121 |
$8K |
| D1352 |
|
184 |
67 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
210 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
13 |
$3K |
| D2330 |
|
24 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
98 |
98 |
$161.70 |
| D0603 |
|
7,225 |
7,165 |
$0.00 |
| D0602 |
|
7,716 |
7,666 |
$0.00 |
| D1999 |
|
588 |
542 |
$0.00 |