| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,393 |
7,889 |
$1.95M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,027 |
5,742 |
$1.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,350 |
1,772 |
$766K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,300 |
5,274 |
$743K |
| D0120 |
Periodic oral evaluation - established patient |
21,077 |
20,888 |
$597K |
| D1120 |
Prophylaxis - child |
16,333 |
16,180 |
$586K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,110 |
21,129 |
$538K |
| D1351 |
Sealant - per tooth |
15,901 |
4,878 |
$426K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,629 |
13,362 |
$355K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,411 |
22,208 |
$323K |
| D0220 |
Intraoral - periapical first radiographic image |
22,506 |
22,250 |
$275K |
| D1110 |
Prophylaxis - adult |
5,038 |
4,990 |
$268K |
| D0274 |
Bitewings - four radiographic images |
5,183 |
5,134 |
$175K |
| D0272 |
Bitewings - two radiographic images |
7,609 |
7,540 |
$174K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
355 |
178 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
434 |
429 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
635 |
627 |
$22K |
| D2330 |
|
149 |
83 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
552 |
548 |
$9K |
| D2331 |
|
31 |
18 |
$3K |
| D7111 |
|
235 |
162 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$400.93 |
| D0603 |
|
29,045 |
28,832 |
$0.00 |