| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,463 |
822 |
$5K |
| D1120 |
Prophylaxis - child |
4,501 |
4,404 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
850 |
351 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,368 |
733 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,270 |
4,471 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,384 |
2,307 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
716 |
395 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,299 |
4,208 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
6,053 |
5,190 |
$2K |
| D1351 |
Sealant - per tooth |
2,193 |
678 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
2,678 |
2,658 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,438 |
1,150 |
$984.09 |
| D1110 |
Prophylaxis - adult |
400 |
393 |
$676.12 |
| D0210 |
Intraoral - complete series of radiographic images |
268 |
241 |
$513.18 |
| D0140 |
Limited oral evaluation - problem focused |
391 |
358 |
$468.12 |
| D1206 |
Topical application of fluoride varnish |
299 |
291 |
$312.06 |
| D0272 |
Bitewings - two radiographic images |
432 |
420 |
$291.55 |
| D0274 |
Bitewings - four radiographic images |
294 |
283 |
$285.77 |
| D0330 |
Panoramic radiographic image |
290 |
280 |
$246.93 |
| D0160 |
|
296 |
288 |
$205.84 |
| D0145 |
Oral evaluation for a patient under three years of age |
75 |
70 |
$164.58 |
| D0190 |
|
561 |
493 |
$108.65 |
| D3240 |
|
45 |
26 |
$80.01 |
| D0270 |
|
70 |
65 |
$18.28 |
| D0603 |
|
204 |
176 |
$0.00 |
| D0601 |
|
290 |
247 |
$0.00 |
| D0602 |
|
31 |
26 |
$0.00 |
| D0350 |
|
187 |
64 |
$0.00 |
| D1354 |
|
31 |
12 |
$0.00 |