| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,527 |
3,735 |
$871K |
| D1351 |
Sealant - per tooth |
13,846 |
3,694 |
$379K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,835 |
1,761 |
$223K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,386 |
1,384 |
$195K |
| D1120 |
Prophylaxis - child |
4,939 |
4,926 |
$180K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,886 |
5,768 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
5,075 |
5,048 |
$145K |
| D1110 |
Prophylaxis - adult |
2,455 |
2,449 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,687 |
4,576 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
1,752 |
1,747 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,630 |
7,609 |
$111K |
| D0274 |
Bitewings - four radiographic images |
2,925 |
2,910 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,434 |
2,429 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
6,034 |
6,003 |
$75K |
| D0272 |
Bitewings - two radiographic images |
2,498 |
2,494 |
$58K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
28 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
196 |
111 |
$6K |
| D2330 |
|
67 |
48 |
$5K |
| D0603 |
|
7,709 |
7,673 |
$0.01 |
| D0602 |
|
708 |
704 |
$0.00 |
| D0601 |
|
296 |
292 |
$0.00 |