| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,699 |
3,333 |
$737K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,619 |
4,510 |
$630K |
| D0120 |
Periodic oral evaluation - established patient |
19,927 |
19,483 |
$551K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,164 |
955 |
$549K |
| D1120 |
Prophylaxis - child |
14,994 |
14,685 |
$525K |
| D1351 |
Sealant - per tooth |
13,719 |
3,797 |
$360K |
| D1110 |
Prophylaxis - adult |
6,268 |
6,119 |
$326K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,533 |
21,069 |
$303K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,767 |
1,709 |
$279K |
| D0274 |
Bitewings - four radiographic images |
7,129 |
6,960 |
$233K |
| D0220 |
Intraoral - periapical first radiographic image |
18,944 |
18,100 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,643 |
16,218 |
$192K |
| D0272 |
Bitewings - two radiographic images |
10,154 |
9,949 |
$172K |
| D0330 |
Panoramic radiographic image |
3,109 |
3,054 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,423 |
4,233 |
$114K |
| D9248 |
|
933 |
862 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
772 |
772 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,301 |
1,259 |
$42K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
544 |
166 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
325 |
222 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
892 |
864 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
69 |
$5K |
| D2332 |
|
37 |
24 |
$5K |
| D2330 |
|
42 |
26 |
$3K |
| D7111 |
|
204 |
127 |
$2K |
| D0250 |
|
14 |
14 |
$165.42 |
| D0603 |
|
26,757 |
26,263 |
$0.00 |