| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,773 |
2,180 |
$548K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,242 |
2,183 |
$298K |
| D0120 |
Periodic oral evaluation - established patient |
7,450 |
7,285 |
$205K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,462 |
371 |
$193K |
| D1120 |
Prophylaxis - child |
5,376 |
5,254 |
$187K |
| D1351 |
Sealant - per tooth |
6,409 |
1,484 |
$167K |
| D1110 |
Prophylaxis - adult |
2,561 |
2,480 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,204 |
7,981 |
$114K |
| D0272 |
Bitewings - two radiographic images |
3,914 |
3,839 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,651 |
2,568 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
7,191 |
6,983 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,985 |
6,703 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,800 |
2,496 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
816 |
798 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
409 |
379 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
66 |
$10K |
| D0350 |
|
691 |
631 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
225 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |
| D0240 |
|
111 |
57 |
$970.20 |
| D0603 |
|
10,752 |
10,460 |
$0.00 |