| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,860 |
4,535 |
$1.48M |
| D0145 |
Oral evaluation for a patient under three years of age |
3,589 |
3,551 |
$491K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,761 |
2,504 |
$447K |
| D1351 |
Sealant - per tooth |
10,783 |
2,863 |
$292K |
| D1120 |
Prophylaxis - child |
6,575 |
6,537 |
$236K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,450 |
7,527 |
$232K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,594 |
352 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
6,328 |
6,297 |
$180K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,517 |
5,431 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,820 |
8,767 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
1,695 |
1,683 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,110 |
3,081 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
8,065 |
7,974 |
$97K |
| D1110 |
Prophylaxis - adult |
1,651 |
1,640 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,475 |
2,457 |
$84K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
923 |
250 |
$76K |
| D9248 |
|
535 |
530 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,227 |
2,214 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
916 |
906 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
61 |
$11K |
| D2934 |
|
41 |
15 |
$6K |
| D0350 |
|
440 |
430 |
$5K |
| D1330 |
|
438 |
434 |
$4K |
| D2330 |
|
19 |
13 |
$1K |
| D0603 |
|
14,278 |
14,166 |
$0.00 |