| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,384 |
4,682 |
$1.43M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,090 |
4,102 |
$987K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,645 |
11,990 |
$289K |
| D1120 |
Prophylaxis - child |
7,888 |
7,869 |
$281K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,873 |
6,848 |
$234K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,356 |
1,354 |
$189K |
| D1110 |
Prophylaxis - adult |
3,572 |
3,564 |
$188K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,543 |
11,515 |
$165K |
| D0274 |
Bitewings - four radiographic images |
4,855 |
4,842 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
12,128 |
12,066 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
5,005 |
4,998 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,871 |
3,851 |
$102K |
| D1351 |
Sealant - per tooth |
3,881 |
1,186 |
$94K |
| D0272 |
Bitewings - two radiographic images |
2,999 |
2,993 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
197 |
26 |
$29K |
| D2330 |
|
363 |
131 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
100 |
26 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$4K |
| D1330 |
|
192 |
192 |
$2K |
| D0603 |
|
13,446 |
13,414 |
$0.00 |