| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,065 |
10,375 |
$2.15M |
| D0145 |
Oral evaluation for a patient under three years of age |
8,725 |
8,689 |
$1.23M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,093 |
6,691 |
$954K |
| D0120 |
Periodic oral evaluation - established patient |
30,324 |
30,230 |
$866K |
| D1351 |
Sealant - per tooth |
28,611 |
8,537 |
$798K |
| D1120 |
Prophylaxis - child |
19,564 |
19,499 |
$709K |
| D1110 |
Prophylaxis - adult |
12,373 |
12,330 |
$669K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,662 |
26,306 |
$548K |
| D1208 |
Topical application of fluoride, excluding varnish |
32,020 |
31,908 |
$465K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,865 |
743 |
$423K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,774 |
14,584 |
$396K |
| D0274 |
Bitewings - four radiographic images |
11,325 |
11,280 |
$387K |
| D0220 |
Intraoral - periapical first radiographic image |
27,829 |
27,635 |
$344K |
| D0330 |
Panoramic radiographic image |
4,756 |
4,740 |
$297K |
| D0272 |
Bitewings - two radiographic images |
8,876 |
8,849 |
$205K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
924 |
286 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,799 |
1,778 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
574 |
432 |
$61K |
| D9248 |
|
485 |
478 |
$58K |
| D2330 |
|
742 |
468 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
944 |
936 |
$18K |
| D1330 |
|
575 |
566 |
$6K |
| D0160 |
|
127 |
127 |
$2K |
| D7111 |
|
124 |
79 |
$1K |
| D0602 |
|
7,352 |
7,324 |
$0.00 |
| D0603 |
|
33,690 |
33,592 |
$0.00 |