| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,090 |
4,006 |
$809K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,252 |
1,109 |
$752K |
| D0120 |
Periodic oral evaluation - established patient |
16,177 |
16,043 |
$460K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,316 |
3,263 |
$451K |
| D1120 |
Prophylaxis - child |
11,734 |
11,640 |
$423K |
| D1110 |
Prophylaxis - adult |
6,510 |
6,453 |
$349K |
| D1206 |
Topical application of fluoride varnish |
16,841 |
16,697 |
$243K |
| D9248 |
|
1,754 |
1,727 |
$204K |
| D0272 |
Bitewings - two radiographic images |
9,051 |
8,974 |
$200K |
| D0274 |
Bitewings - four radiographic images |
6,459 |
6,376 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,513 |
1,518 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
14,803 |
14,653 |
$182K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,938 |
14,132 |
$168K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,400 |
920 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
2,080 |
2,059 |
$139K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,105 |
3,925 |
$107K |
| D1351 |
Sealant - per tooth |
3,510 |
718 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,390 |
619 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,020 |
1,964 |
$67K |
| D0330 |
Panoramic radiographic image |
1,983 |
1,950 |
$49K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
421 |
207 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,504 |
1,490 |
$22K |
| D1330 |
|
283 |
277 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
36 |
$657.30 |
| D7111 |
|
17 |
12 |
$194.99 |
| D1999 |
|
1,021 |
975 |
$0.00 |
| D0602 |
|
10,890 |
10,784 |
$0.00 |
| D0603 |
|
9,932 |
9,841 |
$0.00 |
| D0601 |
|
847 |
828 |
$0.00 |