| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,176 |
5,966 |
$1.24M |
| D0145 |
Oral evaluation for a patient under three years of age |
4,875 |
4,863 |
$684K |
| D1351 |
Sealant - per tooth |
18,497 |
5,592 |
$515K |
| D0120 |
Periodic oral evaluation - established patient |
17,597 |
17,534 |
$502K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,262 |
3,701 |
$491K |
| D1120 |
Prophylaxis - child |
11,693 |
11,653 |
$425K |
| D1110 |
Prophylaxis - adult |
6,638 |
6,612 |
$357K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,049 |
15,092 |
$271K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,608 |
18,541 |
$271K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,279 |
8,916 |
$249K |
| D0274 |
Bitewings - four radiographic images |
6,532 |
6,508 |
$221K |
| D0330 |
Panoramic radiographic image |
3,172 |
3,161 |
$197K |
| D0220 |
Intraoral - periapical first radiographic image |
15,714 |
15,618 |
$194K |
| D0272 |
Bitewings - two radiographic images |
5,679 |
5,659 |
$132K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
607 |
325 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
559 |
425 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,207 |
1,193 |
$41K |
| D2330 |
|
288 |
203 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
534 |
527 |
$10K |
| D7111 |
|
436 |
321 |
$5K |
| D0602 |
|
7,752 |
7,734 |
$0.00 |
| D0603 |
|
15,758 |
15,694 |
$0.00 |
| D0601 |
|
187 |
183 |
$0.00 |