| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,979 |
5,445 |
$1.26M |
| D1351 |
Sealant - per tooth |
33,907 |
8,351 |
$921K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,171 |
2,085 |
$736K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,233 |
5,182 |
$729K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,471 |
4,294 |
$639K |
| D1120 |
Prophylaxis - child |
16,387 |
16,212 |
$583K |
| D0120 |
Periodic oral evaluation - established patient |
20,328 |
20,099 |
$570K |
| D0272 |
Bitewings - two radiographic images |
15,331 |
15,127 |
$330K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,516 |
20,292 |
$293K |
| D0220 |
Intraoral - periapical first radiographic image |
17,701 |
17,449 |
$213K |
| D1110 |
Prophylaxis - adult |
3,835 |
3,789 |
$204K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,003 |
6,755 |
$185K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,688 |
16,298 |
$184K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,107 |
947 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
702 |
448 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
970 |
969 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,681 |
1,666 |
$55K |
| D0330 |
Panoramic radiographic image |
1,981 |
1,956 |
$50K |
| D2332 |
|
225 |
151 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
596 |
586 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,004 |
990 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
43 |
$4K |
| D2335 |
|
17 |
13 |
$2K |
| D0270 |
|
31 |
31 |
$147.00 |
| D0602 |
|
11,396 |
11,309 |
$0.00 |
| D0601 |
|
239 |
231 |
$0.00 |
| D0603 |
|
15,301 |
15,129 |
$0.00 |