| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,562 |
1,451 |
$532K |
| D1351 |
Sealant - per tooth |
6,625 |
1,332 |
$177K |
| D1120 |
Prophylaxis - child |
4,415 |
4,380 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
5,229 |
5,188 |
$146K |
| D0145 |
Oral evaluation for a patient under three years of age |
930 |
925 |
$128K |
| D1110 |
Prophylaxis - adult |
1,686 |
1,666 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,821 |
2,789 |
$84K |
| D1206 |
Topical application of fluoride varnish |
4,906 |
4,861 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,214 |
3,194 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
6,617 |
6,514 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,330 |
6,153 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,460 |
1,388 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
744 |
727 |
$25K |
| D0330 |
Panoramic radiographic image |
884 |
871 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,213 |
1,204 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
109 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
97 |
40 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
189 |
189 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
52 |
24 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
111 |
$2K |
| D0601 |
|
1,977 |
1,969 |
$0.00 |
| D0603 |
|
5,106 |
5,075 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |