| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,746 |
2,798 |
$515K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,135 |
2,550 |
$363K |
| D1351 |
Sealant - per tooth |
9,139 |
2,330 |
$222K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,528 |
729 |
$202K |
| D1120 |
Prophylaxis - child |
6,032 |
5,790 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
7,509 |
7,219 |
$200K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,758 |
7,632 |
$194K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,433 |
1,414 |
$194K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,431 |
4,893 |
$138K |
| D1110 |
Prophylaxis - adult |
2,621 |
2,513 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,605 |
8,260 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
8,565 |
8,102 |
$96K |
| D0272 |
Bitewings - two radiographic images |
3,713 |
3,541 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,402 |
2,285 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
698 |
677 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
864 |
515 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,143 |
1,059 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
374 |
252 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
247 |
133 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
579 |
571 |
$10K |
| D2330 |
|
79 |
44 |
$6K |
| D0603 |
|
10,150 |
9,920 |
$0.01 |
| D0602 |
|
48 |
48 |
$0.00 |