| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,825 |
4,354 |
$1.09M |
| D0145 |
Oral evaluation for a patient under three years of age |
2,775 |
2,753 |
$387K |
| D1351 |
Sealant - per tooth |
11,963 |
3,452 |
$325K |
| D1120 |
Prophylaxis - child |
8,738 |
8,667 |
$316K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,026 |
2,086 |
$311K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,600 |
11,119 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
10,189 |
10,110 |
$289K |
| D1110 |
Prophylaxis - adult |
3,865 |
3,824 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,121 |
13,002 |
$189K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,144 |
5,857 |
$162K |
| D0274 |
Bitewings - four radiographic images |
4,361 |
4,318 |
$147K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,050 |
248 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
11,947 |
11,796 |
$143K |
| D0272 |
Bitewings - two radiographic images |
4,470 |
4,429 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
1,477 |
1,462 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,503 |
2,463 |
$85K |
| D9248 |
|
233 |
231 |
$27K |
| D7240 |
Removal of impacted tooth - completely bony |
40 |
12 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
126 |
70 |
$10K |
| D0350 |
|
322 |
317 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
128 |
$2K |
| D1330 |
|
83 |
83 |
$818.31 |
| D7111 |
|
15 |
12 |
$160.58 |
| D0603 |
|
16,502 |
16,355 |
$0.00 |