| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,518 |
4,917 |
$901K |
| D1351 |
Sealant - per tooth |
26,638 |
6,657 |
$707K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,528 |
3,505 |
$493K |
| D1120 |
Prophylaxis - child |
11,832 |
11,636 |
$420K |
| D0120 |
Periodic oral evaluation - established patient |
13,421 |
13,214 |
$378K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,745 |
13,902 |
$296K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,121 |
16,839 |
$245K |
| D1110 |
Prophylaxis - adult |
4,571 |
4,498 |
$243K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,527 |
8,257 |
$221K |
| D0210 |
Intraoral - complete series of radiographic images |
2,790 |
2,747 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
14,961 |
14,654 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,243 |
1,402 |
$169K |
| D0274 |
Bitewings - four radiographic images |
5,016 |
4,925 |
$166K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
804 |
490 |
$115K |
| D0272 |
Bitewings - two radiographic images |
4,784 |
4,703 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,221 |
3,160 |
$108K |
| D7240 |
Removal of impacted tooth - completely bony |
219 |
66 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
304 |
225 |
$30K |
| D0350 |
|
1,154 |
1,116 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
334 |
325 |
$6K |
| D2330 |
|
36 |
24 |
$3K |
| D2331 |
|
29 |
15 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
13 |
$1K |
| D7111 |
|
88 |
57 |
$1K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$597.20 |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
16 |
$576.54 |
| D1330 |
|
97 |
95 |
$182.53 |
| D0603 |
|
21,488 |
21,199 |
$0.00 |
| D0602 |
|
161 |
159 |
$0.00 |