| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,867 |
5,909 |
$1.48M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,317 |
1,098 |
$1.06M |
| D1351 |
Sealant - per tooth |
37,024 |
7,157 |
$950K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,971 |
5,947 |
$831K |
| D0120 |
Periodic oral evaluation - established patient |
25,535 |
25,356 |
$718K |
| D1120 |
Prophylaxis - child |
16,563 |
16,450 |
$594K |
| D1110 |
Prophylaxis - adult |
10,456 |
10,381 |
$552K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,223 |
27,049 |
$391K |
| D0274 |
Bitewings - four radiographic images |
11,775 |
11,651 |
$383K |
| D0220 |
Intraoral - periapical first radiographic image |
29,832 |
29,519 |
$357K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,552 |
2,687 |
$347K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,157 |
28,238 |
$347K |
| D0272 |
Bitewings - two radiographic images |
13,676 |
13,598 |
$312K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,515 |
3,444 |
$117K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,913 |
3,824 |
$104K |
| D9248 |
|
338 |
333 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
416 |
152 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
453 |
451 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,031 |
1,018 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
207 |
86 |
$13K |
| D0330 |
Panoramic radiographic image |
432 |
422 |
$10K |
| D0160 |
|
334 |
331 |
$5K |
| D2332 |
|
21 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$2K |
| D2330 |
|
21 |
13 |
$2K |
| D7111 |
|
15 |
12 |
$160.58 |
| D0603 |
|
25,621 |
25,495 |
$0.00 |
| D0602 |
|
9,502 |
9,437 |
$0.00 |