| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,913 |
1,557 |
$479K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,362 |
2,314 |
$323K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,710 |
432 |
$236K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,677 |
829 |
$124K |
| D1120 |
Prophylaxis - child |
3,476 |
3,391 |
$120K |
| D1351 |
Sealant - per tooth |
3,578 |
1,012 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,196 |
1,165 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,831 |
2,743 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,754 |
2,557 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,615 |
3,296 |
$70K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
840 |
264 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,660 |
4,536 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,794 |
1,745 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,628 |
3,501 |
$42K |
| D1110 |
Prophylaxis - adult |
768 |
751 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,402 |
1,362 |
$31K |
| D9248 |
|
251 |
237 |
$27K |
| D0274 |
Bitewings - four radiographic images |
422 |
408 |
$14K |
| D0160 |
|
310 |
299 |
$4K |
| D1330 |
|
271 |
260 |
$3K |
| D7111 |
|
83 |
41 |
$952.01 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$431.94 |
| D0350 |
|
18 |
17 |
$110.28 |
| D0603 |
|
8,463 |
8,237 |
$0.00 |