| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,863 |
1,589 |
$271K |
| D1351 |
Sealant - per tooth |
9,734 |
1,828 |
$206K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,638 |
1,583 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,486 |
6,086 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
5,450 |
5,276 |
$123K |
| D1120 |
Prophylaxis - child |
3,972 |
3,847 |
$107K |
| D1110 |
Prophylaxis - adult |
2,261 |
2,198 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,412 |
3,297 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,424 |
711 |
$78K |
| D1206 |
Topical application of fluoride varnish |
6,109 |
5,923 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
6,687 |
6,420 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,289 |
1,218 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
206 |
78 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
795 |
760 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
295 |
191 |
$21K |
| D0272 |
Bitewings - two radiographic images |
991 |
967 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
41 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
110 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$473.06 |
| D0603 |
|
4,714 |
4,580 |
$0.30 |
| D0602 |
|
2,424 |
2,389 |
$0.15 |
| D0601 |
|
623 |
582 |
$0.06 |