| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,018 |
742 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
1,589 |
1,550 |
$106K |
| D1351 |
Sealant - per tooth |
4,348 |
964 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,095 |
556 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,693 |
1,652 |
$57K |
| D1120 |
Prophylaxis - child |
1,596 |
1,548 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,385 |
2,316 |
$33K |
| D1110 |
Prophylaxis - adult |
651 |
631 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,226 |
1,172 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,782 |
611 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
117 |
54 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
113 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
506 |
483 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
765 |
726 |
$9K |
| D0350 |
|
793 |
767 |
$5K |
| D2332 |
|
40 |
15 |
$5K |
| D0274 |
Bitewings - four radiographic images |
56 |
53 |
$2K |
| D0272 |
Bitewings - two radiographic images |
73 |
67 |
$1K |
| D1330 |
|
32 |
32 |
$12.25 |
| D0603 |
|
2,813 |
2,756 |
$0.00 |