| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,479 |
10,330 |
$2.00M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,971 |
5,705 |
$770K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,484 |
5,448 |
$767K |
| D1120 |
Prophylaxis - child |
21,325 |
21,145 |
$760K |
| D0120 |
Periodic oral evaluation - established patient |
25,102 |
24,862 |
$710K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47,220 |
20,161 |
$529K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,507 |
27,250 |
$393K |
| D0210 |
Intraoral - complete series of radiographic images |
5,581 |
5,526 |
$374K |
| D1351 |
Sealant - per tooth |
13,256 |
4,064 |
$359K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,501 |
13,278 |
$353K |
| D0220 |
Intraoral - periapical first radiographic image |
21,602 |
21,373 |
$264K |
| D1110 |
Prophylaxis - adult |
4,667 |
4,610 |
$246K |
| D0272 |
Bitewings - two radiographic images |
6,684 |
6,627 |
$153K |
| D0274 |
Bitewings - four radiographic images |
3,987 |
3,937 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
607 |
405 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
714 |
525 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,247 |
1,240 |
$43K |
| D2330 |
|
183 |
127 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
159 |
111 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
335 |
319 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
33 |
$2K |
| D7111 |
|
26 |
12 |
$298.22 |
| D0603 |
|
35,034 |
34,803 |
$0.00 |