| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,563 |
3,079 |
$650K |
| D1351 |
Sealant - per tooth |
15,181 |
2,487 |
$527K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,942 |
2,258 |
$369K |
| D0210 |
Intraoral - complete series of radiographic images |
3,077 |
3,024 |
$319K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,140 |
1,373 |
$309K |
| D1110 |
Prophylaxis - adult |
4,048 |
3,977 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,346 |
4,283 |
$210K |
| D1120 |
Prophylaxis - child |
4,813 |
4,745 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
6,035 |
5,949 |
$199K |
| D1206 |
Topical application of fluoride varnish |
7,429 |
7,336 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,739 |
776 |
$175K |
| D0274 |
Bitewings - four radiographic images |
2,985 |
2,936 |
$119K |
| D0140 |
Limited oral evaluation - problem focused |
1,922 |
1,878 |
$91K |
| D2332 |
|
540 |
318 |
$82K |
| D2330 |
|
500 |
312 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,362 |
1,215 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,897 |
2,815 |
$52K |
| D2335 |
|
273 |
176 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,654 |
1,635 |
$52K |
| D9420 |
|
301 |
301 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
228 |
56 |
$42K |
| D4341 |
|
226 |
84 |
$42K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
315 |
77 |
$34K |
| D2331 |
|
238 |
165 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,098 |
943 |
$32K |
| D2394 |
|
119 |
103 |
$26K |
| D4346 |
|
148 |
148 |
$18K |
| D0240 |
|
856 |
449 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
27 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
187 |
185 |
$6K |
| D0330 |
Panoramic radiographic image |
84 |
75 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
180 |
180 |
$4K |
| D0603 |
|
289 |
289 |
$3K |
| D3120 |
|
30 |
16 |
$2K |
| D0270 |
|
25 |
25 |
$495.41 |