| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,480 |
2,392 |
$455K |
| D1351 |
Sealant - per tooth |
12,014 |
2,694 |
$212K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,410 |
454 |
$145K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,338 |
1,321 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,456 |
1,391 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
5,264 |
5,161 |
$113K |
| D1110 |
Prophylaxis - adult |
2,493 |
2,447 |
$97K |
| D1120 |
Prophylaxis - child |
3,564 |
3,498 |
$92K |
| D1206 |
Topical application of fluoride varnish |
6,027 |
5,919 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,570 |
5,685 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,263 |
2,213 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,094 |
3,016 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
6,235 |
6,060 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,642 |
2,596 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
431 |
193 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,054 |
1,032 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
345 |
338 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
182 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
75 |
71 |
$948.15 |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$896.84 |
| D1330 |
|
1,824 |
1,776 |
$237.53 |
| D0601 |
|
3,943 |
3,878 |
$15.89 |
| D0603 |
|
3,699 |
3,609 |
$2.06 |