| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,805 |
6,763 |
$1.46M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,744 |
3,454 |
$444K |
| D0120 |
Periodic oral evaluation - established patient |
15,463 |
15,288 |
$438K |
| D1120 |
Prophylaxis - child |
9,757 |
9,638 |
$350K |
| D1351 |
Sealant - per tooth |
12,214 |
4,045 |
$324K |
| D1110 |
Prophylaxis - adult |
5,422 |
5,363 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,988 |
12,962 |
$278K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,982 |
1,960 |
$275K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,291 |
9,097 |
$241K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,365 |
16,175 |
$235K |
| D0220 |
Intraoral - periapical first radiographic image |
13,725 |
13,539 |
$168K |
| D0274 |
Bitewings - four radiographic images |
4,703 |
4,638 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
2,193 |
2,183 |
$147K |
| D0272 |
Bitewings - two radiographic images |
3,767 |
3,722 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
587 |
374 |
$56K |
| D2330 |
|
487 |
352 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
41 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
227 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
56 |
$4K |
| D0350 |
|
53 |
53 |
$604.70 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$165.26 |
| D0603 |
|
19,749 |
19,553 |
$0.00 |
| D0601 |
|
19 |
19 |
$0.00 |