| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,971 |
8,282 |
$1.83M |
| D0145 |
Oral evaluation for a patient under three years of age |
5,450 |
5,390 |
$761K |
| D1351 |
Sealant - per tooth |
21,408 |
6,733 |
$591K |
| D0120 |
Periodic oral evaluation - established patient |
19,463 |
19,280 |
$551K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,635 |
3,681 |
$518K |
| D1120 |
Prophylaxis - child |
11,794 |
11,682 |
$422K |
| D1110 |
Prophylaxis - adult |
7,421 |
7,344 |
$396K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,434 |
1,311 |
$356K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,313 |
11,951 |
$329K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,456 |
16,361 |
$328K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,602 |
19,408 |
$282K |
| D0274 |
Bitewings - four radiographic images |
7,274 |
7,217 |
$246K |
| D0330 |
Panoramic radiographic image |
3,508 |
3,469 |
$214K |
| D0220 |
Intraoral - periapical first radiographic image |
17,303 |
17,084 |
$212K |
| D0272 |
Bitewings - two radiographic images |
5,203 |
5,162 |
$120K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
627 |
431 |
$65K |
| D2330 |
|
718 |
442 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,082 |
1,064 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
217 |
109 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
773 |
749 |
$14K |
| D2332 |
|
68 |
42 |
$9K |
| D7111 |
|
491 |
310 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$3K |
| D2331 |
|
13 |
12 |
$1K |
| D0603 |
|
23,984 |
23,762 |
$0.00 |
| D0602 |
|
2,378 |
2,347 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |