| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,519 |
1,857 |
$458K |
| D1110 |
Prophylaxis - adult |
5,449 |
5,389 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
9,507 |
9,395 |
$268K |
| D1351 |
Sealant - per tooth |
9,222 |
2,413 |
$249K |
| D0274 |
Bitewings - four radiographic images |
6,046 |
5,971 |
$188K |
| D1120 |
Prophylaxis - child |
4,176 |
4,131 |
$150K |
| D1206 |
Topical application of fluoride varnish |
9,258 |
9,157 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,276 |
716 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,023 |
2,895 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,981 |
2,954 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
3,318 |
3,243 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
201 |
198 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,559 |
2,186 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
168 |
89 |
$25K |
| D0330 |
Panoramic radiographic image |
518 |
507 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
114 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
345 |
342 |
$5K |
| D0603 |
|
7,369 |
7,314 |
$0.00 |
| D0602 |
|
2,655 |
2,628 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |