| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,471 |
3,791 |
$1.03M |
| D0145 |
Oral evaluation for a patient under three years of age |
3,623 |
3,552 |
$486K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,371 |
746 |
$480K |
| D0120 |
Periodic oral evaluation - established patient |
12,815 |
12,707 |
$351K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,873 |
1,964 |
$340K |
| D1120 |
Prophylaxis - child |
9,917 |
9,813 |
$339K |
| D1110 |
Prophylaxis - adult |
4,164 |
4,108 |
$210K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,130 |
13,957 |
$193K |
| D0274 |
Bitewings - four radiographic images |
4,941 |
4,893 |
$160K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,668 |
12,412 |
$160K |
| D0220 |
Intraoral - periapical first radiographic image |
12,920 |
12,783 |
$154K |
| D0272 |
Bitewings - two radiographic images |
5,831 |
5,776 |
$132K |
| D1351 |
Sealant - per tooth |
4,799 |
1,156 |
$124K |
| D9248 |
|
667 |
656 |
$78K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
783 |
219 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,817 |
1,752 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
837 |
814 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,078 |
2,000 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
140 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
303 |
175 |
$14K |
| D0350 |
|
178 |
176 |
$3K |
| D2331 |
|
18 |
12 |
$2K |
| D0603 |
|
18,945 |
18,661 |
$0.00 |
| D1999 |
|
1,196 |
1,092 |
$0.00 |