| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,947 |
3,751 |
$820K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,084 |
2,201 |
$296K |
| D0210 |
Intraoral - complete series of radiographic images |
3,083 |
2,981 |
$202K |
| D1351 |
Sealant - per tooth |
7,888 |
2,077 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,303 |
5,080 |
$168K |
| D1120 |
Prophylaxis - child |
4,349 |
4,174 |
$149K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,379 |
3,044 |
$98K |
| D0145 |
Oral evaluation for a patient under three years of age |
770 |
737 |
$89K |
| D1110 |
Prophylaxis - adult |
1,750 |
1,667 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,094 |
5,833 |
$84K |
| D0274 |
Bitewings - four radiographic images |
1,317 |
1,230 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,262 |
3,055 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,051 |
1,017 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
993 |
945 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
252 |
172 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
157 |
89 |
$21K |
| D0272 |
Bitewings - two radiographic images |
834 |
783 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
117 |
66 |
$9K |
| D2331 |
|
53 |
30 |
$5K |
| D2330 |
|
65 |
52 |
$5K |
| D2332 |
|
19 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
27 |
$2K |
| D7111 |
|
27 |
16 |
$298.22 |
| D0602 |
|
675 |
646 |
$0.00 |
| D0603 |
|
6,407 |
6,009 |
$0.00 |