| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,189 |
1,439 |
$379K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,514 |
656 |
$328K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,578 |
1,557 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
7,496 |
7,195 |
$189K |
| D1110 |
Prophylaxis - adult |
3,444 |
3,262 |
$158K |
| D1120 |
Prophylaxis - child |
4,558 |
4,449 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,872 |
621 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,226 |
5,099 |
$122K |
| D9248 |
|
1,194 |
1,092 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,329 |
7,090 |
$98K |
| D1351 |
Sealant - per tooth |
4,358 |
864 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,083 |
370 |
$81K |
| D0272 |
Bitewings - two radiographic images |
3,280 |
3,185 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
6,210 |
5,983 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,905 |
1,765 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,957 |
1,823 |
$30K |
| D0350 |
|
1,649 |
1,595 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
157 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
891 |
864 |
$19K |
| D0330 |
Panoramic radiographic image |
715 |
670 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
453 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
77 |
$6K |
| D7111 |
|
598 |
318 |
$6K |
| D0160 |
|
124 |
119 |
$1K |
| D9239 |
|
27 |
26 |
$961.39 |
| D1206 |
Topical application of fluoride varnish |
66 |
64 |
$779.10 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$777.04 |
| D9243 |
|
18 |
13 |
$519.33 |
| D1330 |
|
131 |
124 |
$491.25 |
| D0603 |
|
2,456 |
2,402 |
$0.00 |
| D0601 |
|
5,109 |
5,022 |
$0.00 |
| D0602 |
|
1,307 |
1,282 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$0.00 |