| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,994 |
6,574 |
$1.17M |
| D0120 |
Periodic oral evaluation - established patient |
19,278 |
19,055 |
$544K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,333 |
3,799 |
$488K |
| D1120 |
Prophylaxis - child |
13,314 |
13,168 |
$476K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,307 |
16,001 |
$393K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,097 |
2,078 |
$292K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,875 |
19,646 |
$285K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,615 |
10,422 |
$275K |
| D1351 |
Sealant - per tooth |
9,128 |
2,937 |
$243K |
| D1110 |
Prophylaxis - adult |
4,457 |
4,405 |
$239K |
| D0220 |
Intraoral - periapical first radiographic image |
17,143 |
16,921 |
$209K |
| D0210 |
Intraoral - complete series of radiographic images |
2,100 |
2,078 |
$136K |
| D0272 |
Bitewings - two radiographic images |
5,153 |
5,093 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,132 |
3,091 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
103 |
$2K |
| D2330 |
|
18 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$494.48 |
| D0603 |
|
24,432 |
24,205 |
$0.00 |