| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,222 |
10,224 |
$1.98M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,246 |
2,475 |
$1.05M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,085 |
7,088 |
$1.01M |
| D0145 |
Oral evaluation for a patient under three years of age |
5,755 |
5,692 |
$806K |
| D0120 |
Periodic oral evaluation - established patient |
27,356 |
27,198 |
$781K |
| D1120 |
Prophylaxis - child |
20,853 |
20,728 |
$755K |
| D1351 |
Sealant - per tooth |
24,839 |
8,179 |
$673K |
| D0230 |
Intraoral - periapical each additional radiographic image |
55,198 |
23,464 |
$618K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,389 |
17,822 |
$485K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,697 |
28,531 |
$417K |
| D1110 |
Prophylaxis - adult |
6,799 |
6,764 |
$366K |
| D0220 |
Intraoral - periapical first radiographic image |
25,150 |
24,918 |
$309K |
| D0210 |
Intraoral - complete series of radiographic images |
4,311 |
4,285 |
$292K |
| D0274 |
Bitewings - four radiographic images |
5,756 |
5,726 |
$195K |
| D0272 |
Bitewings - two radiographic images |
8,431 |
8,386 |
$195K |
| D0350 |
|
5,245 |
5,227 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
296 |
221 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
889 |
876 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,125 |
1,110 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
122 |
63 |
$9K |
| D2330 |
|
83 |
65 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$960.90 |
| D7111 |
|
33 |
25 |
$344.10 |
| D0603 |
|
34,964 |
34,755 |
$0.00 |
| D0602 |
|
652 |
649 |
$0.00 |
| D0601 |
|
25 |
25 |
$0.00 |