| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,850 |
1,733 |
$360K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,082 |
2,017 |
$264K |
| D1120 |
Prophylaxis - child |
5,083 |
4,962 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,013 |
5,878 |
$165K |
| D1351 |
Sealant - per tooth |
5,500 |
1,787 |
$143K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,794 |
6,995 |
$128K |
| D1110 |
Prophylaxis - adult |
2,069 |
2,018 |
$107K |
| D0272 |
Bitewings - two radiographic images |
4,748 |
4,629 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,160 |
6,985 |
$100K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
681 |
384 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
7,299 |
7,084 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,163 |
2,108 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,015 |
1,844 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
544 |
311 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,275 |
1,227 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
45 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
29 |
$4K |
| D9248 |
|
12 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$169.02 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$14.38 |
| D0603 |
|
9,544 |
9,285 |
$0.00 |