| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,168 |
2,800 |
$599K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,248 |
3,232 |
$452K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,743 |
2,914 |
$439K |
| D1351 |
Sealant - per tooth |
12,521 |
3,205 |
$334K |
| D1120 |
Prophylaxis - child |
6,953 |
6,908 |
$249K |
| D0120 |
Periodic oral evaluation - established patient |
7,846 |
7,802 |
$223K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,085 |
7,951 |
$214K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,395 |
9,342 |
$135K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,540 |
4,398 |
$119K |
| D1110 |
Prophylaxis - adult |
1,989 |
1,981 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
8,484 |
8,399 |
$104K |
| D0272 |
Bitewings - two radiographic images |
3,303 |
3,283 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,127 |
1,116 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,394 |
1,390 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,343 |
1,322 |
$45K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
219 |
94 |
$32K |
| D7240 |
Removal of impacted tooth - completely bony |
96 |
28 |
$28K |
| D9248 |
|
68 |
68 |
$8K |
| D2330 |
|
93 |
62 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
59 |
19 |
$5K |
| D2934 |
|
35 |
16 |
$5K |
| D2332 |
|
17 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D2331 |
|
16 |
13 |
$1K |
| D0160 |
|
84 |
84 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$512.48 |
| D7111 |
|
24 |
12 |
$252.34 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0603 |
|
13,540 |
13,435 |
$0.00 |