| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22,379 |
6,570 |
$2.19M |
| D0145 |
Oral evaluation for a patient under three years of age |
7,300 |
7,199 |
$995K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,479 |
3,310 |
$788K |
| D0120 |
Periodic oral evaluation - established patient |
26,499 |
26,061 |
$738K |
| D1120 |
Prophylaxis - child |
17,639 |
17,354 |
$624K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,831 |
863 |
$525K |
| D1110 |
Prophylaxis - adult |
9,248 |
9,079 |
$486K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,092 |
26,632 |
$385K |
| D1351 |
Sealant - per tooth |
13,841 |
3,295 |
$365K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,867 |
22,209 |
$325K |
| D0220 |
Intraoral - periapical first radiographic image |
24,289 |
23,688 |
$291K |
| D0274 |
Bitewings - four radiographic images |
8,480 |
8,337 |
$281K |
| D0272 |
Bitewings - two radiographic images |
14,712 |
14,466 |
$257K |
| D0330 |
Panoramic radiographic image |
4,059 |
3,958 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,825 |
3,692 |
$99K |
| D9248 |
|
854 |
802 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,198 |
1,198 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
548 |
176 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,116 |
1,081 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
173 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,276 |
1,231 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
237 |
138 |
$11K |
| D1206 |
Topical application of fluoride varnish |
598 |
583 |
$8K |
| D2330 |
|
104 |
57 |
$8K |
| D7111 |
|
396 |
241 |
$4K |
| D0603 |
|
36,032 |
35,347 |
$0.96 |