| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,956 |
9,297 |
$2.07M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,006 |
4,985 |
$701K |
| D0120 |
Periodic oral evaluation - established patient |
23,140 |
23,065 |
$663K |
| D1120 |
Prophylaxis - child |
15,714 |
15,661 |
$570K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,844 |
3,797 |
$537K |
| D1110 |
Prophylaxis - adult |
7,495 |
7,473 |
$407K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,202 |
14,004 |
$366K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,195 |
19,567 |
$351K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,098 |
24,020 |
$351K |
| D1351 |
Sealant - per tooth |
12,733 |
4,409 |
$351K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,853 |
641 |
$272K |
| D0210 |
Intraoral - complete series of radiographic images |
3,781 |
3,770 |
$261K |
| D0220 |
Intraoral - periapical first radiographic image |
20,755 |
20,641 |
$257K |
| D0274 |
Bitewings - four radiographic images |
6,737 |
6,714 |
$231K |
| D0272 |
Bitewings - two radiographic images |
8,919 |
8,893 |
$207K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,349 |
873 |
$133K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,097 |
430 |
$91K |
| D2330 |
|
564 |
389 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
374 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
387 |
381 |
$7K |
| D2331 |
|
43 |
25 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
26 |
$2K |
| D7111 |
|
116 |
85 |
$1K |
| D0603 |
|
29,512 |
29,376 |
$0.00 |