| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,929 |
1,670 |
$318K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,521 |
5,539 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,305 |
955 |
$153K |
| D1351 |
Sealant - per tooth |
6,474 |
1,167 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
5,488 |
5,219 |
$136K |
| D1120 |
Prophylaxis - child |
4,165 |
3,941 |
$128K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,034 |
969 |
$123K |
| D1110 |
Prophylaxis - adult |
1,759 |
1,682 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,634 |
2,503 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
6,410 |
5,877 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,196 |
3,089 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,766 |
2,593 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
216 |
70 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,248 |
1,138 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,184 |
1,123 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
95 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
472 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
231 |
$15K |
| D2332 |
|
19 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
37 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
84 |
$1K |
| D0603 |
|
5,834 |
5,591 |
$9.03 |
| D0431 |
|
133 |
118 |
$0.00 |
| D0601 |
|
689 |
638 |
$0.00 |
| D0602 |
|
133 |
124 |
$0.00 |