| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,524 |
8,816 |
$1.74M |
| D0145 |
Oral evaluation for a patient under three years of age |
5,889 |
5,873 |
$824K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,461 |
4,118 |
$584K |
| D1120 |
Prophylaxis - child |
16,041 |
15,981 |
$578K |
| D0120 |
Periodic oral evaluation - established patient |
17,777 |
17,716 |
$508K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,428 |
16,263 |
$449K |
| D1351 |
Sealant - per tooth |
15,557 |
4,892 |
$424K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,464 |
13,093 |
$356K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,195 |
1,167 |
$321K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,530 |
20,458 |
$297K |
| D0210 |
Intraoral - complete series of radiographic images |
3,803 |
3,781 |
$254K |
| D0220 |
Intraoral - periapical first radiographic image |
17,477 |
17,393 |
$215K |
| D1110 |
Prophylaxis - adult |
3,185 |
3,179 |
$171K |
| D0272 |
Bitewings - two radiographic images |
6,127 |
6,111 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,350 |
2,339 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,146 |
2,140 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
53 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
375 |
375 |
$7K |
| D2332 |
|
21 |
12 |
$3K |
| D7111 |
|
17 |
14 |
$194.99 |
| D0601 |
|
117 |
117 |
$0.00 |
| D0603 |
|
27,828 |
27,736 |
$0.00 |