| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,470 |
1,138 |
$323K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,136 |
2,100 |
$295K |
| D1120 |
Prophylaxis - child |
5,054 |
5,019 |
$174K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,182 |
234 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
5,661 |
5,631 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,901 |
729 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,980 |
6,938 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,546 |
5,862 |
$83K |
| D1110 |
Prophylaxis - adult |
1,559 |
1,556 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,257 |
2,246 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
6,135 |
6,092 |
$74K |
| D1351 |
Sealant - per tooth |
2,827 |
604 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,537 |
2,523 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,323 |
1,305 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,361 |
1,311 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
346 |
105 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
340 |
335 |
$22K |
| D9248 |
|
106 |
106 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
42 |
$3K |
| D0350 |
|
83 |
83 |
$2K |
| D0603 |
|
9,968 |
9,875 |
$0.00 |
| D1999 |
|
513 |
482 |
$0.00 |