| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,825 |
4,040 |
$1.26M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,392 |
1,411 |
$261K |
| D0210 |
Intraoral - complete series of radiographic images |
3,434 |
3,379 |
$232K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,723 |
976 |
$172K |
| D1120 |
Prophylaxis - child |
4,635 |
4,584 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,832 |
4,760 |
$162K |
| D1351 |
Sealant - per tooth |
5,602 |
1,828 |
$143K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,642 |
4,562 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,637 |
2,928 |
$106K |
| D1110 |
Prophylaxis - adult |
1,871 |
1,835 |
$98K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
712 |
346 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,652 |
6,562 |
$94K |
| D0145 |
Oral evaluation for a patient under three years of age |
661 |
653 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
1,737 |
1,708 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,962 |
2,919 |
$36K |
| D0274 |
Bitewings - four radiographic images |
879 |
868 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
213 |
132 |
$17K |
| D0272 |
Bitewings - two radiographic images |
612 |
608 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D7111 |
|
35 |
24 |
$355.57 |
| D0603 |
|
7,615 |
7,472 |
$0.00 |