| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,160 |
1,908 |
$496K |
| D0120 |
Periodic oral evaluation - established patient |
5,397 |
5,316 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,953 |
691 |
$148K |
| D1120 |
Prophylaxis - child |
3,659 |
3,602 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,649 |
4,944 |
$129K |
| D0145 |
Oral evaluation for a patient under three years of age |
661 |
656 |
$92K |
| D1110 |
Prophylaxis - adult |
1,685 |
1,661 |
$89K |
| D1351 |
Sealant - per tooth |
3,203 |
989 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,483 |
2,440 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,648 |
5,562 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
5,488 |
5,374 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,449 |
1,351 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,189 |
1,171 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
226 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
24 |
$5K |
| D2332 |
|
23 |
13 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
43 |
$1K |
| D0330 |
Panoramic radiographic image |
44 |
42 |
$1K |
| D0603 |
|
6,687 |
6,591 |
$0.00 |