| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,528 |
6,710 |
$1.09M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,176 |
7,014 |
$980K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,497 |
3,140 |
$614K |
| D1120 |
Prophylaxis - child |
20,429 |
20,228 |
$585K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,206 |
4,483 |
$535K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,442 |
27,175 |
$486K |
| D0120 |
Periodic oral evaluation - established patient |
24,340 |
24,109 |
$417K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,115 |
12,772 |
$371K |
| D1110 |
Prophylaxis - adult |
7,060 |
6,988 |
$277K |
| D0272 |
Bitewings - two radiographic images |
12,104 |
11,967 |
$207K |
| D0210 |
Intraoral - complete series of radiographic images |
5,432 |
3,306 |
$131K |
| D1351 |
Sealant - per tooth |
4,574 |
1,914 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
12,043 |
11,785 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,708 |
5,464 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,910 |
1,887 |
$50K |
| D9920 |
|
435 |
427 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
819 |
806 |
$21K |
| D0240 |
|
1,904 |
1,890 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
132 |
92 |
$10K |
| D2330 |
|
149 |
104 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
320 |
315 |
$5K |
| D1354 |
|
548 |
133 |
$4K |
| D1510 |
|
32 |
28 |
$3K |
| D9110 |
|
29 |
25 |
$818.48 |
| D3110 |
|
38 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
25 |
$0.00 |