| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,608 |
2,831 |
$561K |
| D0120 |
Periodic oral evaluation - established patient |
12,378 |
12,304 |
$351K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,453 |
2,346 |
$343K |
| D1351 |
Sealant - per tooth |
11,194 |
3,156 |
$305K |
| D1120 |
Prophylaxis - child |
8,294 |
8,243 |
$298K |
| D1110 |
Prophylaxis - adult |
4,899 |
4,871 |
$264K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,702 |
1,694 |
$239K |
| D0274 |
Bitewings - four radiographic images |
5,879 |
5,843 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,079 |
13,003 |
$190K |
| D0272 |
Bitewings - two radiographic images |
6,554 |
6,516 |
$143K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
927 |
355 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,903 |
2,729 |
$77K |
| D0330 |
Panoramic radiographic image |
1,338 |
1,329 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,331 |
2,294 |
$27K |
| D9248 |
|
219 |
210 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
298 |
298 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
359 |
357 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
694 |
684 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
204 |
$2K |
| D0603 |
|
10,157 |
10,096 |
$0.00 |
| D0602 |
|
2,660 |
2,651 |
$0.00 |
| D0601 |
|
2,118 |
2,103 |
$0.00 |