| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,219 |
3,532 |
$906K |
| D1351 |
Sealant - per tooth |
17,428 |
4,543 |
$458K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,138 |
2,187 |
$304K |
| D1120 |
Prophylaxis - child |
8,527 |
8,462 |
$293K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,353 |
13,581 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
9,867 |
9,754 |
$276K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,962 |
1,945 |
$274K |
| D1110 |
Prophylaxis - adult |
4,645 |
4,601 |
$241K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,375 |
13,267 |
$185K |
| D0274 |
Bitewings - four radiographic images |
5,789 |
5,700 |
$162K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,036 |
411 |
$151K |
| D0220 |
Intraoral - periapical first radiographic image |
14,376 |
14,147 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,120 |
4,048 |
$139K |
| D0272 |
Bitewings - two radiographic images |
3,749 |
3,723 |
$81K |
| D9248 |
|
568 |
550 |
$61K |
| D0330 |
Panoramic radiographic image |
2,032 |
1,989 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
406 |
208 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
592 |
567 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,140 |
1,104 |
$30K |
| D0273 |
|
563 |
555 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
32 |
12 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
311 |
$6K |
| D7111 |
|
65 |
41 |
$745.55 |
| D0270 |
|
65 |
64 |
$308.21 |
| D0603 |
|
16,984 |
16,814 |
$0.01 |