| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,172 |
1,088 |
$404K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,706 |
1,684 |
$229K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,650 |
4,709 |
$153K |
| D1120 |
Prophylaxis - child |
3,737 |
3,695 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,776 |
3,737 |
$106K |
| D1351 |
Sealant - per tooth |
3,843 |
685 |
$101K |
| D0272 |
Bitewings - two radiographic images |
3,601 |
3,555 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,384 |
4,336 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,939 |
4,862 |
$59K |
| D1110 |
Prophylaxis - adult |
899 |
898 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,472 |
1,435 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
387 |
164 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
137 |
66 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
232 |
104 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
410 |
401 |
$14K |
| D0274 |
Bitewings - four radiographic images |
448 |
447 |
$9K |
| D0603 |
|
6,109 |
6,036 |
$0.00 |