| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,754 |
3,855 |
$675K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,435 |
3,398 |
$481K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,895 |
3,490 |
$459K |
| D0120 |
Periodic oral evaluation - established patient |
15,585 |
15,501 |
$444K |
| D1110 |
Prophylaxis - adult |
7,710 |
7,654 |
$411K |
| D1120 |
Prophylaxis - child |
11,369 |
11,289 |
$409K |
| D1351 |
Sealant - per tooth |
13,967 |
4,306 |
$381K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,353 |
700 |
$338K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,981 |
18,852 |
$275K |
| D0274 |
Bitewings - four radiographic images |
8,334 |
8,278 |
$269K |
| D0272 |
Bitewings - two radiographic images |
10,498 |
10,385 |
$235K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,414 |
5,275 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,577 |
3,510 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
6,197 |
6,085 |
$73K |
| D9248 |
|
548 |
534 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,058 |
3,664 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
331 |
241 |
$35K |
| D0330 |
Panoramic radiographic image |
1,341 |
1,332 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
302 |
298 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
327 |
$6K |
| D0350 |
|
270 |
266 |
$2K |
| D9420 |
|
26 |
26 |
$944.06 |
| D7111 |
|
22 |
13 |
$229.40 |
| D0603 |
|
24,374 |
24,101 |
$0.00 |
| D0601 |
|
32 |
32 |
$0.00 |