| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,167 |
1,157 |
$204K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,179 |
1,144 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
5,640 |
5,464 |
$153K |
| D1110 |
Prophylaxis - adult |
2,709 |
2,623 |
$136K |
| D1351 |
Sealant - per tooth |
5,104 |
889 |
$130K |
| D1120 |
Prophylaxis - child |
3,319 |
3,215 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,287 |
742 |
$98K |
| D0272 |
Bitewings - two radiographic images |
3,943 |
3,830 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,992 |
5,805 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
620 |
454 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
629 |
608 |
$40K |
| D0274 |
Bitewings - four radiographic images |
631 |
609 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
608 |
519 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
326 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
85 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
25 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
279 |
272 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
38 |
27 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
152 |
140 |
$2K |
| D0602 |
|
7,384 |
7,125 |
$0.00 |