| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,838 |
2,054 |
$684K |
| D7240 |
Removal of impacted tooth - completely bony |
1,206 |
366 |
$337K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,919 |
1,199 |
$303K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,925 |
466 |
$279K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,815 |
1,806 |
$254K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,562 |
3,786 |
$127K |
| D1120 |
Prophylaxis - child |
3,446 |
3,421 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,836 |
3,738 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,224 |
2,205 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,515 |
2,500 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,734 |
4,697 |
$67K |
| D1351 |
Sealant - per tooth |
1,990 |
506 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,142 |
4,091 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
735 |
729 |
$49K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
463 |
161 |
$38K |
| D1110 |
Prophylaxis - adult |
635 |
629 |
$32K |
| D9248 |
|
169 |
164 |
$19K |
| D0274 |
Bitewings - four radiographic images |
526 |
520 |
$17K |
| D0272 |
Bitewings - two radiographic images |
673 |
666 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
299 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
17 |
$5K |
| D0160 |
|
290 |
281 |
$4K |
| D1330 |
|
287 |
278 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
12 |
$2K |
| D0350 |
|
16 |
15 |
$55.14 |
| D0603 |
|
7,915 |
7,861 |
$0.00 |