| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,913 |
7,672 |
$1.67M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,353 |
2,056 |
$775K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,573 |
5,498 |
$773K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,476 |
4,369 |
$727K |
| D1120 |
Prophylaxis - child |
17,224 |
17,031 |
$615K |
| D0120 |
Periodic oral evaluation - established patient |
20,645 |
20,417 |
$585K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,596 |
20,118 |
$542K |
| D1351 |
Sealant - per tooth |
19,383 |
5,653 |
$521K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,489 |
12,879 |
$350K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,022 |
22,760 |
$331K |
| D0220 |
Intraoral - periapical first radiographic image |
21,469 |
21,149 |
$261K |
| D1110 |
Prophylaxis - adult |
4,787 |
4,731 |
$256K |
| D0272 |
Bitewings - two radiographic images |
7,525 |
7,435 |
$172K |
| D0210 |
Intraoral - complete series of radiographic images |
2,011 |
1,986 |
$134K |
| D0274 |
Bitewings - four radiographic images |
3,955 |
3,904 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,850 |
1,830 |
$63K |
| D0350 |
|
4,813 |
4,746 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
199 |
143 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
680 |
667 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
61 |
43 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
25 |
$2K |
| D7111 |
|
69 |
53 |
$745.55 |
| D0603 |
|
30,165 |
29,883 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |