| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,843 |
8,055 |
$1.44M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,867 |
4,502 |
$603K |
| D0120 |
Periodic oral evaluation - established patient |
20,543 |
20,310 |
$580K |
| D1120 |
Prophylaxis - child |
15,214 |
15,047 |
$543K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,206 |
3,181 |
$446K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,676 |
17,245 |
$408K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,730 |
12,444 |
$332K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,536 |
21,274 |
$309K |
| D1351 |
Sealant - per tooth |
9,749 |
3,211 |
$260K |
| D1110 |
Prophylaxis - adult |
4,580 |
4,514 |
$244K |
| D0220 |
Intraoral - periapical first radiographic image |
18,497 |
18,247 |
$225K |
| D0210 |
Intraoral - complete series of radiographic images |
2,873 |
2,837 |
$181K |
| D0272 |
Bitewings - two radiographic images |
6,328 |
6,264 |
$145K |
| D0274 |
Bitewings - four radiographic images |
3,148 |
3,103 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
500 |
355 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
209 |
135 |
$30K |
| D2332 |
|
68 |
42 |
$9K |
| D2330 |
|
108 |
76 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
88 |
57 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
136 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
96 |
$2K |
| D2331 |
|
17 |
12 |
$2K |
| D0350 |
|
92 |
92 |
$604.70 |
| D0603 |
|
26,867 |
26,624 |
$0.00 |