| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,938 |
1,297 |
$261K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,986 |
1,940 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
7,013 |
6,659 |
$184K |
| D1120 |
Prophylaxis - child |
5,299 |
5,042 |
$176K |
| D1351 |
Sealant - per tooth |
7,408 |
1,410 |
$171K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,785 |
5,792 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,526 |
798 |
$106K |
| D1110 |
Prophylaxis - adult |
2,103 |
1,976 |
$103K |
| D1206 |
Topical application of fluoride varnish |
6,582 |
6,269 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,085 |
2,951 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
6,781 |
6,422 |
$74K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
345 |
79 |
$48K |
| D0330 |
Panoramic radiographic image |
1,225 |
1,146 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,760 |
1,676 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
850 |
753 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
471 |
442 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
776 |
710 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
855 |
788 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
524 |
500 |
$9K |
| D9248 |
|
60 |
59 |
$7K |
| D9243 |
|
33 |
14 |
$1K |
| D9239 |
|
14 |
14 |
$741.52 |
| D9610 |
|
15 |
14 |
$250.88 |
| D0270 |
|
14 |
13 |
$49.00 |
| D0603 |
|
9,964 |
9,632 |
$0.12 |
| D4341 |
|
82 |
13 |
$0.00 |