| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,185 |
639 |
$114K |
| D0145 |
Oral evaluation for a patient under three years of age |
629 |
614 |
$84K |
| D1120 |
Prophylaxis - child |
2,391 |
2,280 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
592 |
208 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,535 |
2,418 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,203 |
2,098 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,659 |
1,406 |
$41K |
| D1351 |
Sealant - per tooth |
1,437 |
430 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,250 |
2,152 |
$26K |
| D0274 |
Bitewings - four radiographic images |
782 |
753 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,817 |
1,724 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
169 |
$23K |
| D0272 |
Bitewings - two radiographic images |
742 |
705 |
$16K |
| D0350 |
|
1,004 |
894 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,004 |
975 |
$14K |
| D1110 |
Prophylaxis - adult |
278 |
266 |
$14K |
| D0330 |
Panoramic radiographic image |
75 |
72 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
122 |
$4K |
| D0240 |
|
83 |
47 |
$744.80 |
| D0602 |
|
2,066 |
2,009 |
$0.00 |
| D0603 |
|
1,472 |
1,445 |
$0.00 |