| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,907 |
3,454 |
$894K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,390 |
4,346 |
$612K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,215 |
1,100 |
$611K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,963 |
7,855 |
$438K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,518 |
2,476 |
$428K |
| D1351 |
Sealant - per tooth |
13,922 |
3,669 |
$379K |
| D1120 |
Prophylaxis - child |
7,087 |
7,063 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
7,766 |
7,740 |
$222K |
| D0210 |
Intraoral - complete series of radiographic images |
2,828 |
2,809 |
$191K |
| D1110 |
Prophylaxis - adult |
3,175 |
3,158 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,086 |
10,044 |
$146K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,720 |
4,460 |
$125K |
| D9248 |
|
963 |
936 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,979 |
2,958 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,208 |
8,132 |
$101K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,035 |
388 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
791 |
431 |
$43K |
| D7240 |
Removal of impacted tooth - completely bony |
50 |
13 |
$14K |
| D2330 |
|
133 |
81 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
428 |
417 |
$8K |
| D2335 |
|
21 |
12 |
$3K |
| D7111 |
|
275 |
150 |
$3K |
| D1510 |
|
16 |
12 |
$2K |
| D9243 |
|
44 |
15 |
$855.60 |
| D9310 |
|
37 |
37 |
$539.46 |
| D9239 |
|
15 |
15 |
$456.32 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$327.32 |
| D9610 |
|
15 |
15 |
$250.88 |
| D1330 |
|
15 |
15 |
$134.75 |
| D0603 |
|
15,280 |
15,179 |
$0.00 |
| D9986 |
|
2,113 |
1,932 |
$0.00 |