| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24,573 |
12,619 |
$1.94M |
| D0145 |
Oral evaluation for a patient under three years of age |
9,783 |
9,745 |
$1.38M |
| D0120 |
Periodic oral evaluation - established patient |
41,842 |
41,710 |
$1.20M |
| D1120 |
Prophylaxis - child |
30,855 |
30,745 |
$1.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,909 |
4,356 |
$707K |
| D1110 |
Prophylaxis - adult |
12,859 |
12,824 |
$698K |
| D1208 |
Topical application of fluoride, excluding varnish |
44,484 |
44,337 |
$648K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47,084 |
17,711 |
$495K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,933 |
17,800 |
$481K |
| D0274 |
Bitewings - four radiographic images |
12,063 |
12,032 |
$397K |
| D0272 |
Bitewings - two radiographic images |
13,607 |
13,566 |
$303K |
| D0220 |
Intraoral - periapical first radiographic image |
19,413 |
19,352 |
$222K |
| D0210 |
Intraoral - complete series of radiographic images |
3,100 |
3,096 |
$217K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
700 |
398 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,234 |
1,222 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
768 |
763 |
$14K |
| D1351 |
Sealant - per tooth |
108 |
29 |
$3K |
| D0330 |
Panoramic radiographic image |
519 |
519 |
$1K |
| D2330 |
|
12 |
12 |
$922.91 |
| D7111 |
|
35 |
30 |
$401.45 |
| D0602 |
|
26,672 |
26,579 |
$0.00 |
| D0603 |
|
28,066 |
27,963 |
$0.00 |