| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,968 |
2,205 |
$479K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,496 |
1,485 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
7,004 |
6,951 |
$198K |
| D1120 |
Prophylaxis - child |
5,500 |
5,459 |
$197K |
| D1351 |
Sealant - per tooth |
5,664 |
1,712 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,823 |
1,003 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
1,680 |
1,663 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,851 |
7,793 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,767 |
5,503 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,428 |
3,365 |
$89K |
| D1110 |
Prophylaxis - adult |
1,585 |
1,570 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
5,956 |
5,897 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,053 |
2,039 |
$70K |
| D0272 |
Bitewings - two radiographic images |
1,746 |
1,730 |
$40K |
| D7240 |
Removal of impacted tooth - completely bony |
134 |
42 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
328 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
47 |
30 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
63 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$701.58 |
| D0350 |
|
31 |
31 |
$218.72 |
| D0603 |
|
10,565 |
10,506 |
$0.00 |