| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,916 |
8,367 |
$2.01M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22,827 |
8,664 |
$1.77M |
| D0120 |
Periodic oral evaluation - established patient |
17,033 |
17,014 |
$490K |
| D1120 |
Prophylaxis - child |
11,196 |
11,179 |
$410K |
| D1110 |
Prophylaxis - adult |
7,129 |
7,124 |
$389K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,481 |
12,371 |
$337K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,256 |
2,251 |
$319K |
| D0274 |
Bitewings - four radiographic images |
8,705 |
8,700 |
$300K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,401 |
18,380 |
$269K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,517 |
15,802 |
$246K |
| D1351 |
Sealant - per tooth |
7,735 |
3,458 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
16,353 |
16,243 |
$204K |
| D0210 |
Intraoral - complete series of radiographic images |
2,684 |
2,683 |
$185K |
| D0272 |
Bitewings - two radiographic images |
5,718 |
5,710 |
$133K |
| D2330 |
|
1,352 |
854 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,291 |
1,291 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
447 |
338 |
$44K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
111 |
70 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
109 |
70 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
297 |
$5K |
| D2332 |
|
32 |
27 |
$4K |
| D2331 |
|
33 |
26 |
$3K |
| D2335 |
|
21 |
13 |
$3K |
| D0270 |
|
14 |
14 |
$87.08 |
| D0603 |
|
20,757 |
20,725 |
$0.00 |