| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,363 |
7,353 |
$1.41M |
| D1351 |
Sealant - per tooth |
36,181 |
9,700 |
$984K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,445 |
6,775 |
$887K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,676 |
1,095 |
$808K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,071 |
5,031 |
$704K |
| D1120 |
Prophylaxis - child |
16,704 |
16,587 |
$601K |
| D0120 |
Periodic oral evaluation - established patient |
17,643 |
17,522 |
$502K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,470 |
18,596 |
$483K |
| D7240 |
Removal of impacted tooth - completely bony |
1,252 |
417 |
$354K |
| D0210 |
Intraoral - complete series of radiographic images |
5,176 |
5,132 |
$350K |
| D1110 |
Prophylaxis - adult |
6,505 |
6,458 |
$349K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,849 |
23,694 |
$345K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,428 |
12,065 |
$331K |
| D0220 |
Intraoral - periapical first radiographic image |
19,912 |
19,731 |
$244K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,900 |
6,820 |
$235K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,745 |
756 |
$222K |
| D0274 |
Bitewings - four radiographic images |
5,494 |
5,462 |
$186K |
| D0272 |
Bitewings - two radiographic images |
7,627 |
7,577 |
$176K |
| D2934 |
|
243 |
67 |
$33K |
| D9239 |
|
515 |
513 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
485 |
268 |
$28K |
| D9243 |
|
515 |
512 |
$21K |
| D2330 |
|
191 |
120 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
454 |
$8K |
| D7230 |
|
20 |
13 |
$3K |
| D2332 |
|
19 |
13 |
$2K |
| D0160 |
|
84 |
84 |
$1K |
| D1330 |
|
84 |
81 |
$797.25 |
| D7111 |
|
60 |
38 |
$665.26 |
| D0603 |
|
30,935 |
30,677 |
$0.00 |