| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,646 |
4,254 |
$931K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,268 |
4,242 |
$593K |
| D1351 |
Sealant - per tooth |
21,113 |
4,950 |
$578K |
| D1120 |
Prophylaxis - child |
11,008 |
10,933 |
$393K |
| D0120 |
Periodic oral evaluation - established patient |
12,141 |
12,067 |
$343K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,253 |
13,118 |
$247K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,608 |
14,511 |
$209K |
| D1110 |
Prophylaxis - adult |
3,476 |
3,455 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,402 |
1,515 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
13,978 |
13,784 |
$170K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,254 |
6,072 |
$165K |
| D0272 |
Bitewings - two radiographic images |
6,838 |
6,806 |
$157K |
| D0274 |
Bitewings - four radiographic images |
3,762 |
3,737 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,457 |
2,436 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,239 |
1,228 |
$81K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
408 |
242 |
$59K |
| D0350 |
|
1,485 |
1,469 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
100 |
71 |
$10K |
| D2330 |
|
106 |
69 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
362 |
359 |
$6K |
| D7111 |
|
214 |
153 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$1K |
| D0603 |
|
17,212 |
17,097 |
$0.00 |
| D0602 |
|
1,657 |
1,647 |
$0.00 |