| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,919 |
1,291 |
$224K |
| D1351 |
Sealant - per tooth |
6,253 |
1,221 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,396 |
4,138 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,517 |
3,412 |
$82K |
| D1120 |
Prophylaxis - child |
2,750 |
2,666 |
$76K |
| D0145 |
Oral evaluation for a patient under three years of age |
683 |
669 |
$76K |
| D1110 |
Prophylaxis - adult |
1,714 |
1,666 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,157 |
646 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,703 |
4,576 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,980 |
4,761 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
313 |
134 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,142 |
1,102 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,150 |
1,095 |
$25K |
| D0272 |
Bitewings - two radiographic images |
917 |
909 |
$17K |
| D0330 |
Panoramic radiographic image |
774 |
737 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
99 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
25 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
200 |
184 |
$4K |
| D0603 |
|
6,000 |
5,844 |
$0.04 |