| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,153 |
3,306 |
$617K |
| D1351 |
Sealant - per tooth |
13,249 |
2,227 |
$394K |
| D1110 |
Prophylaxis - adult |
5,495 |
5,484 |
$280K |
| D1120 |
Prophylaxis - child |
6,556 |
6,556 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
9,448 |
9,442 |
$259K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,584 |
2,023 |
$237K |
| D1206 |
Topical application of fluoride varnish |
7,888 |
7,888 |
$199K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,103 |
862 |
$160K |
| D0274 |
Bitewings - four radiographic images |
4,261 |
4,259 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
8,153 |
8,079 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,007 |
3,001 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,222 |
783 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,084 |
1,078 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,678 |
1,664 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,693 |
6,532 |
$61K |
| D0272 |
Bitewings - two radiographic images |
1,798 |
1,796 |
$41K |
| D2950 |
|
89 |
68 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
573 |
573 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
125 |
63 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
94 |
57 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
14 |
13 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
29 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$666.60 |
| D1999 |
|
445 |
394 |
$0.00 |