| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,246 |
2,831 |
$612K |
| D1351 |
Sealant - per tooth |
18,225 |
4,455 |
$499K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,644 |
2,620 |
$367K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,156 |
872 |
$309K |
| D1120 |
Prophylaxis - child |
8,353 |
8,247 |
$296K |
| D0120 |
Periodic oral evaluation - established patient |
9,686 |
9,567 |
$272K |
| D9248 |
|
1,692 |
1,632 |
$197K |
| D0272 |
Bitewings - two radiographic images |
7,864 |
7,770 |
$164K |
| D1206 |
Topical application of fluoride varnish |
10,963 |
10,828 |
$157K |
| D1110 |
Prophylaxis - adult |
2,727 |
2,700 |
$145K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,270 |
752 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,258 |
3,215 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,815 |
2,773 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
912 |
911 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,516 |
1,493 |
$52K |
| D0330 |
Panoramic radiographic image |
1,994 |
1,971 |
$46K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
439 |
189 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
475 |
240 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,648 |
2,423 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
336 |
206 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,537 |
1,346 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
443 |
$8K |
| D2330 |
|
24 |
13 |
$2K |
| D1330 |
|
331 |
306 |
$698.75 |
| D1999 |
|
5,471 |
5,323 |
$0.00 |
| D0602 |
|
3,820 |
3,788 |
$0.00 |
| D0603 |
|
9,950 |
9,857 |
$0.00 |