| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,001 |
2,669 |
$702K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,739 |
2,726 |
$385K |
| D1120 |
Prophylaxis - child |
6,868 |
6,837 |
$249K |
| D0120 |
Periodic oral evaluation - established patient |
7,933 |
7,899 |
$227K |
| D1351 |
Sealant - per tooth |
7,896 |
2,022 |
$216K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,168 |
233 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,964 |
9,156 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,706 |
877 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,692 |
8,649 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
9,924 |
9,849 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,073 |
3,048 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,372 |
3,321 |
$90K |
| D1110 |
Prophylaxis - adult |
1,300 |
1,291 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,752 |
2,744 |
$59K |
| D9248 |
|
323 |
311 |
$37K |
| D0330 |
Panoramic radiographic image |
892 |
882 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
378 |
$13K |
| D1206 |
Topical application of fluoride varnish |
527 |
519 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
78 |
26 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$918.32 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0603 |
|
13,160 |
13,092 |
$0.00 |