| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,021 |
5,033 |
$1.26M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,573 |
5,649 |
$1.16M |
| D0145 |
Oral evaluation for a patient under three years of age |
4,292 |
4,231 |
$590K |
| D0120 |
Periodic oral evaluation - established patient |
13,925 |
13,721 |
$388K |
| D1120 |
Prophylaxis - child |
10,272 |
10,115 |
$358K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,746 |
365 |
$242K |
| D1110 |
Prophylaxis - adult |
4,570 |
4,502 |
$238K |
| D0274 |
Bitewings - four radiographic images |
6,906 |
6,792 |
$230K |
| D1351 |
Sealant - per tooth |
8,498 |
2,667 |
$222K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,074 |
14,865 |
$211K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,901 |
13,041 |
$188K |
| D0220 |
Intraoral - periapical first radiographic image |
13,767 |
13,510 |
$167K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,255 |
5,034 |
$136K |
| D0272 |
Bitewings - two radiographic images |
5,010 |
4,924 |
$113K |
| D2330 |
|
1,364 |
774 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,055 |
219 |
$79K |
| D9248 |
|
514 |
510 |
$60K |
| D7240 |
Removal of impacted tooth - completely bony |
155 |
52 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,050 |
1,023 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
368 |
357 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
482 |
234 |
$17K |
| D2934 |
|
94 |
24 |
$12K |
| D0350 |
|
122 |
120 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
107 |
$2K |
| D7111 |
|
77 |
43 |
$802.90 |
| D0603 |
|
20,310 |
20,010 |
$0.00 |
| D1999 |
|
1,591 |
1,517 |
$0.00 |