| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,965 |
6,221 |
$1.46M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,417 |
2,382 |
$1.06M |
| D1351 |
Sealant - per tooth |
34,778 |
9,534 |
$946K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,320 |
6,251 |
$870K |
| D0120 |
Periodic oral evaluation - established patient |
26,997 |
26,884 |
$748K |
| D1120 |
Prophylaxis - child |
21,101 |
21,006 |
$742K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56,503 |
24,797 |
$610K |
| D1110 |
Prophylaxis - adult |
8,919 |
8,878 |
$465K |
| D0220 |
Intraoral - periapical first radiographic image |
26,368 |
26,090 |
$317K |
| D0272 |
Bitewings - two radiographic images |
12,940 |
12,880 |
$293K |
| D0210 |
Intraoral - complete series of radiographic images |
4,443 |
4,421 |
$293K |
| D0274 |
Bitewings - four radiographic images |
7,896 |
7,855 |
$259K |
| D1206 |
Topical application of fluoride varnish |
18,016 |
17,910 |
$255K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,346 |
1,995 |
$253K |
| D9248 |
|
2,125 |
2,061 |
$242K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,659 |
6,302 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,619 |
11,593 |
$165K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,558 |
624 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,556 |
3,524 |
$119K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,415 |
719 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,598 |
1,048 |
$95K |
| D7240 |
Removal of impacted tooth - completely bony |
273 |
128 |
$73K |
| D2934 |
|
369 |
124 |
$53K |
| D2332 |
|
427 |
176 |
$45K |
| D1510 |
|
259 |
214 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,664 |
1,646 |
$30K |
| D2330 |
|
385 |
216 |
$28K |
| D2335 |
|
119 |
52 |
$19K |
| D1354 |
|
426 |
148 |
$5K |
| D0350 |
|
280 |
278 |
$5K |
| D0270 |
|
14 |
14 |
$68.11 |
| D0603 |
|
37,336 |
37,083 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |
| D0601 |
|
35 |
35 |
$0.00 |