| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,835 |
3,338 |
$533K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,766 |
15,624 |
$456K |
| D1120 |
Prophylaxis - child |
11,481 |
11,449 |
$415K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,720 |
2,714 |
$383K |
| D0120 |
Periodic oral evaluation - established patient |
13,111 |
13,073 |
$373K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,066 |
16,021 |
$232K |
| D0220 |
Intraoral - periapical first radiographic image |
15,858 |
15,791 |
$177K |
| D1110 |
Prophylaxis - adult |
2,949 |
2,942 |
$158K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,371 |
5,331 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,204 |
660 |
$122K |
| D0274 |
Bitewings - four radiographic images |
3,242 |
3,234 |
$104K |
| D0272 |
Bitewings - two radiographic images |
3,684 |
3,676 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,703 |
1,699 |
$58K |
| D0330 |
Panoramic radiographic image |
696 |
696 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
116 |
116 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
14 |
$3K |
| D0602 |
|
10,817 |
10,761 |
$0.00 |
| D0603 |
|
8,511 |
8,489 |
$0.00 |