| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,333 |
3,230 |
$626K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,654 |
1,031 |
$524K |
| D1110 |
Prophylaxis - adult |
9,278 |
9,233 |
$488K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,890 |
14,957 |
$469K |
| D0120 |
Periodic oral evaluation - established patient |
14,463 |
14,372 |
$407K |
| D0210 |
Intraoral - complete series of radiographic images |
5,401 |
5,371 |
$359K |
| D1120 |
Prophylaxis - child |
10,006 |
9,960 |
$356K |
| D1351 |
Sealant - per tooth |
12,694 |
2,267 |
$330K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,173 |
2,155 |
$302K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,115 |
20,020 |
$287K |
| D7240 |
Removal of impacted tooth - completely bony |
902 |
284 |
$250K |
| D0274 |
Bitewings - four radiographic images |
6,579 |
6,545 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,102 |
6,048 |
$206K |
| D0220 |
Intraoral - periapical first radiographic image |
15,489 |
15,357 |
$188K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,228 |
676 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,930 |
1,153 |
$146K |
| D0272 |
Bitewings - two radiographic images |
2,095 |
2,085 |
$48K |
| D9248 |
|
388 |
383 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,611 |
1,557 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
93 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
80 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
12 |
$3K |
| D0602 |
|
7,600 |
7,570 |
$63.00 |
| D0603 |
|
15,792 |
15,698 |
$18.09 |
| D0601 |
|
296 |
296 |
$0.00 |