| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,718 |
1,019 |
$264K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,412 |
689 |
$109K |
| D0145 |
Oral evaluation for a patient under three years of age |
557 |
553 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,011 |
1,004 |
$69K |
| D1351 |
Sealant - per tooth |
1,759 |
535 |
$47K |
| D1120 |
Prophylaxis - child |
1,252 |
1,243 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,108 |
1,098 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,347 |
1,228 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,709 |
1,699 |
$24K |
| D1110 |
Prophylaxis - adult |
442 |
440 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
715 |
714 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,745 |
761 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
110 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
810 |
803 |
$10K |
| D0272 |
Bitewings - two radiographic images |
293 |
293 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43 |
25 |
$6K |
| D0274 |
Bitewings - four radiographic images |
122 |
122 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$242.26 |
| D0603 |
|
2,406 |
2,391 |
$0.00 |