| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,264 |
3,422 |
$939K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,737 |
2,620 |
$445K |
| D0210 |
Intraoral - complete series of radiographic images |
3,365 |
3,339 |
$231K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,119 |
1,102 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,246 |
4,211 |
$146K |
| D1120 |
Prophylaxis - child |
3,509 |
3,477 |
$126K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,017 |
3,957 |
$106K |
| D1351 |
Sealant - per tooth |
3,859 |
1,002 |
$102K |
| D1110 |
Prophylaxis - adult |
1,520 |
1,499 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,266 |
5,216 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,111 |
1,874 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,153 |
1,133 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,031 |
1,973 |
$23K |
| D0274 |
Bitewings - four radiographic images |
383 |
375 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
53 |
26 |
$8K |
| D2330 |
|
47 |
21 |
$3K |
| D0272 |
Bitewings - two radiographic images |
96 |
93 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$1K |
| D1330 |
|
65 |
64 |
$502.60 |
| D0603 |
|
6,926 |
6,848 |
$0.00 |
| D3120 |
|
24 |
12 |
$0.00 |