| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,225 |
3,601 |
$710K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,336 |
4,406 |
$708K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,133 |
2,099 |
$285K |
| D1351 |
Sealant - per tooth |
10,297 |
3,412 |
$270K |
| D1120 |
Prophylaxis - child |
7,538 |
7,445 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
9,270 |
9,188 |
$260K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,171 |
9,232 |
$229K |
| D1110 |
Prophylaxis - adult |
4,046 |
4,013 |
$212K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,769 |
11,642 |
$167K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
981 |
380 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
9,824 |
9,642 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,196 |
3,172 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,012 |
3,834 |
$98K |
| D0330 |
Panoramic radiographic image |
1,544 |
1,535 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,580 |
2,529 |
$85K |
| D0272 |
Bitewings - two radiographic images |
2,906 |
2,877 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
827 |
816 |
$55K |
| D9248 |
|
300 |
293 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
365 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
28 |
$4K |
| D2330 |
|
36 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
34 |
33 |
$294.00 |
| D0603 |
|
14,154 |
13,994 |
$0.00 |