| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,575 |
5,703 |
$1.15M |
| D0145 |
Oral evaluation for a patient under three years of age |
5,962 |
5,948 |
$834K |
| D0120 |
Periodic oral evaluation - established patient |
28,614 |
28,557 |
$817K |
| D1120 |
Prophylaxis - child |
20,243 |
20,195 |
$733K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,897 |
4,801 |
$691K |
| D1110 |
Prophylaxis - adult |
11,209 |
11,186 |
$606K |
| D1351 |
Sealant - per tooth |
21,327 |
4,294 |
$581K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,826 |
1,088 |
$560K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,835 |
26,528 |
$482K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,838 |
31,762 |
$462K |
| D0220 |
Intraoral - periapical first radiographic image |
27,993 |
27,860 |
$347K |
| D9248 |
|
2,628 |
2,614 |
$313K |
| D0210 |
Intraoral - complete series of radiographic images |
4,559 |
4,547 |
$310K |
| D0274 |
Bitewings - four radiographic images |
8,591 |
8,575 |
$294K |
| D0272 |
Bitewings - two radiographic images |
11,839 |
11,814 |
$274K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,899 |
3,757 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,769 |
2,754 |
$96K |
| D7240 |
Removal of impacted tooth - completely bony |
171 |
71 |
$49K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
501 |
241 |
$41K |
| D0350 |
|
2,039 |
2,011 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
221 |
142 |
$22K |
| D7230 |
|
113 |
43 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
880 |
871 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
160 |
$15K |
| D1330 |
|
215 |
214 |
$2K |
| D0603 |
|
37,457 |
37,371 |
$0.00 |
| D0602 |
|
611 |
609 |
$0.00 |