| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,572 |
3,058 |
$583K |
| D1351 |
Sealant - per tooth |
18,873 |
3,046 |
$347K |
| D1120 |
Prophylaxis - child |
10,698 |
10,608 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
12,049 |
11,950 |
$246K |
| D1110 |
Prophylaxis - adult |
6,478 |
6,421 |
$236K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,679 |
2,655 |
$222K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,830 |
317 |
$181K |
| D0274 |
Bitewings - four radiographic images |
7,549 |
7,485 |
$147K |
| D1206 |
Topical application of fluoride varnish |
14,375 |
14,276 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,473 |
5,403 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,478 |
776 |
$109K |
| D0272 |
Bitewings - two radiographic images |
7,933 |
7,870 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,609 |
1,607 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
6,614 |
6,461 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,753 |
2,568 |
$47K |
| D0330 |
Panoramic radiographic image |
4,122 |
4,083 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
946 |
506 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,761 |
5,242 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
671 |
173 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,356 |
1,323 |
$18K |
| D7240 |
Removal of impacted tooth - completely bony |
143 |
43 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
125 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
729 |
724 |
$8K |
| D0350 |
|
301 |
299 |
$2K |
| D2332 |
|
28 |
12 |
$2K |
| D0270 |
|
467 |
455 |
$1K |
| D0603 |
|
17,166 |
16,934 |
$72.35 |
| D0602 |
|
2,702 |
2,680 |
$0.02 |
| D1999 |
|
438 |
390 |
$0.00 |
| D0601 |
|
136 |
136 |
$0.00 |