| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,179 |
1,736 |
$412K |
| D1110 |
Prophylaxis - adult |
6,253 |
6,196 |
$328K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,287 |
2,260 |
$319K |
| D0120 |
Periodic oral evaluation - established patient |
11,169 |
11,076 |
$315K |
| D1120 |
Prophylaxis - child |
6,504 |
6,457 |
$233K |
| D0274 |
Bitewings - four radiographic images |
6,309 |
6,277 |
$214K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,905 |
11,832 |
$172K |
| D0210 |
Intraoral - complete series of radiographic images |
2,508 |
2,485 |
$165K |
| D1351 |
Sealant - per tooth |
5,142 |
1,417 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
9,919 |
9,835 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,612 |
9,528 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,089 |
434 |
$86K |
| D0272 |
Bitewings - two radiographic images |
3,002 |
2,986 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,792 |
1,617 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
668 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
99 |
13 |
$15K |
| D0170 |
|
141 |
140 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
70 |
$1K |
| D9420 |
|
26 |
26 |
$944.06 |
| D0603 |
|
15,106 |
14,993 |
$0.00 |