| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,823 |
6,424 |
$1.68M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,528 |
4,457 |
$852K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,934 |
1,098 |
$847K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,998 |
3,903 |
$548K |
| D0120 |
Periodic oral evaluation - established patient |
18,887 |
18,777 |
$530K |
| D1120 |
Prophylaxis - child |
13,365 |
13,275 |
$465K |
| D1110 |
Prophylaxis - adult |
7,583 |
7,543 |
$395K |
| D7240 |
Removal of impacted tooth - completely bony |
1,349 |
473 |
$369K |
| D0274 |
Bitewings - four radiographic images |
10,608 |
10,559 |
$358K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,370 |
21,234 |
$298K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,235 |
759 |
$254K |
| D9248 |
|
2,141 |
2,122 |
$253K |
| D0220 |
Intraoral - periapical first radiographic image |
19,960 |
19,815 |
$244K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,077 |
19,187 |
$236K |
| D1351 |
Sealant - per tooth |
4,894 |
1,334 |
$126K |
| D0272 |
Bitewings - two radiographic images |
5,248 |
5,193 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,484 |
2,456 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
975 |
480 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,676 |
1,622 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
650 |
641 |
$43K |
| D7230 |
|
44 |
25 |
$7K |
| D0350 |
|
422 |
419 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
29 |
$4K |
| D7111 |
|
57 |
42 |
$642.32 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
24 |
$394.38 |
| D1999 |
|
1,659 |
1,617 |
$0.00 |
| D0603 |
|
26,701 |
26,421 |
$0.00 |