| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,366 |
4,125 |
$830K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,836 |
5,798 |
$821K |
| D0120 |
Periodic oral evaluation - established patient |
18,468 |
18,324 |
$527K |
| D1120 |
Prophylaxis - child |
14,480 |
14,363 |
$526K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,068 |
3,240 |
$470K |
| D1351 |
Sealant - per tooth |
13,698 |
3,468 |
$381K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,316 |
19,153 |
$281K |
| D0272 |
Bitewings - two radiographic images |
11,221 |
11,124 |
$237K |
| D1110 |
Prophylaxis - adult |
4,333 |
4,296 |
$235K |
| D0220 |
Intraoral - periapical first radiographic image |
15,756 |
15,587 |
$190K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,550 |
6,352 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,176 |
14,793 |
$167K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,060 |
638 |
$156K |
| D0274 |
Bitewings - four radiographic images |
3,896 |
3,859 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
1,297 |
1,295 |
$90K |
| D0330 |
Panoramic radiographic image |
2,487 |
2,453 |
$56K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
199 |
117 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
417 |
406 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
210 |
206 |
$4K |
| D2330 |
|
20 |
14 |
$1K |
| D0603 |
|
13,726 |
13,610 |
$0.00 |
| D0602 |
|
9,633 |
9,552 |
$0.00 |
| D0601 |
|
2,001 |
1,989 |
$0.00 |