| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,784 |
2,656 |
$690K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,395 |
697 |
$474K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,067 |
3,027 |
$421K |
| D7240 |
Removal of impacted tooth - completely bony |
1,117 |
387 |
$314K |
| D0120 |
Periodic oral evaluation - established patient |
9,909 |
9,789 |
$271K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,825 |
1,515 |
$271K |
| D1120 |
Prophylaxis - child |
7,897 |
7,788 |
$270K |
| D1110 |
Prophylaxis - adult |
3,304 |
3,261 |
$168K |
| D1351 |
Sealant - per tooth |
6,379 |
1,700 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,376 |
11,215 |
$156K |
| D9248 |
|
1,201 |
1,190 |
$142K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,120 |
9,582 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
10,025 |
9,870 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,586 |
3,552 |
$117K |
| D0272 |
Bitewings - two radiographic images |
4,725 |
4,646 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,007 |
445 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
821 |
202 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,056 |
1,950 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
748 |
734 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,400 |
1,359 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
109 |
$8K |
| D7230 |
|
44 |
25 |
$7K |
| D0350 |
|
173 |
173 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$450.72 |
| D7111 |
|
30 |
13 |
$344.10 |
| D1999 |
|
944 |
880 |
$0.00 |
| D0603 |
|
14,943 |
14,735 |
$0.00 |