| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,038 |
7,173 |
$2.06M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25,974 |
8,710 |
$1.97M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,026 |
1,106 |
$843K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,350 |
5,293 |
$742K |
| D0120 |
Periodic oral evaluation - established patient |
16,908 |
16,796 |
$473K |
| D1120 |
Prophylaxis - child |
13,408 |
13,319 |
$467K |
| D7240 |
Removal of impacted tooth - completely bony |
1,331 |
452 |
$370K |
| D1110 |
Prophylaxis - adult |
5,924 |
5,881 |
$306K |
| D0274 |
Bitewings - four radiographic images |
8,545 |
8,490 |
$287K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,602 |
16,704 |
$274K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,451 |
19,307 |
$271K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,734 |
9,551 |
$255K |
| D1351 |
Sealant - per tooth |
9,210 |
3,498 |
$238K |
| D0220 |
Intraoral - periapical first radiographic image |
17,518 |
17,359 |
$214K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,332 |
578 |
$181K |
| D9248 |
|
1,494 |
1,486 |
$178K |
| D0272 |
Bitewings - two radiographic images |
5,623 |
5,570 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,523 |
2,493 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,034 |
1,014 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
526 |
268 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
206 |
101 |
$19K |
| D2934 |
|
136 |
31 |
$19K |
| D2330 |
|
263 |
150 |
$19K |
| D1352 |
|
257 |
91 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
364 |
362 |
$7K |
| D0350 |
|
77 |
77 |
$1K |
| D7111 |
|
18 |
13 |
$172.05 |
| D1999 |
|
1,569 |
1,496 |
$0.00 |
| D0603 |
|
25,737 |
25,501 |
$0.00 |