| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,316 |
2,424 |
$534K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,274 |
2,250 |
$318K |
| D1351 |
Sealant - per tooth |
7,904 |
1,999 |
$216K |
| D1120 |
Prophylaxis - child |
5,457 |
5,431 |
$198K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,258 |
262 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
6,311 |
6,294 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,772 |
8,089 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,727 |
1,062 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,699 |
7,670 |
$112K |
| D0274 |
Bitewings - four radiographic images |
3,592 |
3,575 |
$107K |
| D1110 |
Prophylaxis - adult |
1,929 |
1,924 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
8,660 |
8,598 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,282 |
2,225 |
$61K |
| D9248 |
|
437 |
432 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,346 |
1,329 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,726 |
1,716 |
$35K |
| D0330 |
Panoramic radiographic image |
1,388 |
1,375 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
198 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
86 |
28 |
$7K |
| D1206 |
Topical application of fluoride varnish |
318 |
314 |
$5K |
| D2330 |
|
21 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$2K |
| D2331 |
|
14 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$223.48 |
| D0603 |
|
11,126 |
11,062 |
$0.00 |