| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,828 |
1,331 |
$285K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,514 |
783 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,747 |
1,702 |
$59K |
| D1120 |
Prophylaxis - child |
1,541 |
1,495 |
$54K |
| D1351 |
Sealant - per tooth |
1,815 |
602 |
$49K |
| D1110 |
Prophylaxis - adult |
880 |
859 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,689 |
1,632 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,484 |
2,415 |
$35K |
| D0330 |
Panoramic radiographic image |
1,394 |
1,348 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
477 |
477 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,319 |
1,279 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,448 |
1,064 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
183 |
177 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
683 |
661 |
$19K |
| D0272 |
Bitewings - two radiographic images |
856 |
835 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,172 |
1,139 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
91 |
53 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
30 |
$4K |
| D2330 |
|
21 |
13 |
$1K |
| D0603 |
|
2,827 |
2,769 |
$0.00 |