| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,615 |
4,444 |
$1.03M |
| D0145 |
Oral evaluation for a patient under three years of age |
2,975 |
2,962 |
$416K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,175 |
390 |
$314K |
| D1120 |
Prophylaxis - child |
8,628 |
8,559 |
$308K |
| D1351 |
Sealant - per tooth |
10,142 |
3,157 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
8,913 |
8,836 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,244 |
1,850 |
$245K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,127 |
9,315 |
$200K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,830 |
6,701 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,264 |
11,171 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
2,093 |
2,067 |
$136K |
| D0220 |
Intraoral - periapical first radiographic image |
10,173 |
10,056 |
$120K |
| D7240 |
Removal of impacted tooth - completely bony |
337 |
111 |
$95K |
| D1110 |
Prophylaxis - adult |
1,678 |
1,664 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,124 |
2,114 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,151 |
3,124 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,836 |
1,825 |
$63K |
| D9248 |
|
546 |
536 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
733 |
203 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
324 |
208 |
$32K |
| D0160 |
|
837 |
810 |
$12K |
| D1330 |
|
819 |
795 |
$8K |
| D7230 |
|
20 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
178 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$2K |
| D2330 |
|
24 |
15 |
$2K |
| D0350 |
|
39 |
38 |
$496.26 |
| D0603 |
|
16,316 |
16,151 |
$0.00 |