| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,350 |
3,485 |
$216K |
| D1351 |
Sealant - per tooth |
14,210 |
3,321 |
$216K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,833 |
3,570 |
$198K |
| D1120 |
Prophylaxis - child |
8,368 |
8,280 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
8,534 |
8,477 |
$166K |
| D1110 |
Prophylaxis - adult |
5,255 |
5,218 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,059 |
5,010 |
$98K |
| D2740 |
Crown - porcelain/ceramic |
189 |
142 |
$91K |
| D1206 |
Topical application of fluoride varnish |
6,249 |
6,202 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,197 |
7,135 |
$78K |
| D0330 |
Panoramic radiographic image |
4,317 |
4,269 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,988 |
2,917 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,076 |
1,063 |
$40K |
| D0272 |
Bitewings - two radiographic images |
5,624 |
5,571 |
$28K |
| D0603 |
|
3,435 |
3,404 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
414 |
350 |
$13K |
| D2950 |
|
192 |
145 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
302 |
230 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,118 |
1,036 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
168 |
142 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
369 |
365 |
$6K |
| D4341 |
|
107 |
38 |
$5K |
| D0601 |
|
347 |
340 |
$3K |
| D9920 |
|
280 |
269 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
63 |
$2K |
| D2330 |
|
39 |
29 |
$2K |
| D0274 |
Bitewings - four radiographic images |
127 |
127 |
$2K |
| D2331 |
|
16 |
13 |
$750.00 |
| D4355 |
|
12 |
12 |
$600.00 |
| D0220 |
Intraoral - periapical first radiographic image |
163 |
163 |
$512.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
152 |
$483.00 |
| D0602 |
|
40 |
39 |
$370.00 |
| D0270 |
|
16 |
15 |
$70.00 |